Interstitial laser thermotherapy in neurosurgery: A review

Abstract

One of the most recent laser treatment modalities in neurosurgery is interstitial laser thermotherapy (ILTT). In this review, experimental and clinical studies concerning intracranial ILTT are discussed. Two methods for intra-operative control of the laser induced lesions are described; i.e., computer-controlled power delivery, using a thermocouple that is positioned interstitially at the periphery of the tumour to maintain the desired temperature at that point, and MRI, to visualise the extent of the thermal lesions induced by ILTT. The results show that ILTT using a Nd: YAG laser is easy and relatively effective in the treatment of small deep-seated brain tumours with minimal risk and complications. This review is concluded with suggestions for further improvement of this treatment modality.

Comparative Evaluation of Magnetic Resonance-Guided Focused Ultrasound Surgery for Essential Tremor

“…However, only level IV evidence is available, and we still do not know the superiority or even inferiority of GKS compared to other options [17]. LITT is a technology that delivers laser light to target tissue via optic fibers where the light energy is converted to thermal energy [18]. The recent advances in magnetic resonance-guided LITT allow laser ablation under real-time monitoring.…”

Development of stereotactically guided laser interstitial thermotherapy of breast cancer: In situ measurement and analysis of the temperature field in ex vivo and in vivo adipose tissue

“…LITT has been investigated and used clinically since 1983, as a minimally invasive technique for localized tumor destruction within solid tissues and organs [6][7][8][9][10][11][12][13], especially of the liver, head and neck, brain, and prostate.…”

Stereotactic Laser Ablation for Medically Intractable Epilepsy: The Next Generation of Minimally Invasive Epilepsy Surgery

“…Several other groups soon reported similar results in patients with grades II–III gliomas (69–71); postoperative MRI and histologic analysis revealed well-demarcated volumes of coagulative necrosis (70, 71). As Roux, Bown, and colleagues reviewed in 1996, these histological findings are consistent with a pattern of tissue damage unique to laser thermocoagulation: immediately adjacent to the Nd:YAG laser fiber, a small fibrin-filled cavity is surrounded by a larger volume of dense coagulation, itself encased in a shell of loose coagulation, ultimately transitioning to edema and then normal brain tissue (72). In a similar vein, Schwabe and colleagues defined five discrete regions by comparing pre-contrast T1-, post-contrast T1-, and T2-weighted MRI: a T2-intense catheter track, a T1 pre- and post-contrast-intense central zone, a T2-intense peripheral zone, a T1 post-contrast-enhancing peripheral zone border, and T2-intense surrounding edema (73).…”

“…It was later determined that temperatures between 45 and 90°C cause irreversible coagulation, with cavity formation above 100°C (72, 75). On the other hand, Hayat and Friedburg found that tumor cells may be more thermosensitive, susceptible to damage at temperatures as low as 42.5–45.5°C (72, 76).…”