LITT

Implanted & surgical write · writes

Laser interstitial thermal therapy (LITT) is an MRI-guided treatment in which a thin laser fiber is placed into the brain along a stereotactic path. The fiber delivers continuous or pulsed near-infrared laser energy that heats the surrounding tissue, and real-time MRI thermometry tracks the tissue temperature. The temperature reached sets the result: programmed cell death begins around 45 °C, tissue coagulates irreversibly between 45 and 90 °C, tissue death from protein denaturation sets in around 52 °C and extends across 50 to 80 °C, and cavities form above 100 °C.

Spatial resolution

5–20 mm (suprathreshold extent)

Temporal resolution

n/a

Field of view

12.1 cm³ (treated volume)

Reads

tissue temperature (MR thermometry)

Writes

laser thermal energy delivered to tissue

Destructive?

destructive

Prerequisites

surgery: Burr-hole and stereotactic bolt placement for the intracranial laser probe.; anesthesia: General anaesthesia or sedation according to the workflow. In six awake tumour ablations, light sedation and local anaesthesia were used for head fixation, with mild sedation during ablation.; other: Preprocedural stereotactic MRI and MRI-compatible navigation for targeting, and real-time thermal-isodose MRI monitoring during laser activation.

Theoretical field of view

1.23 L (reachable envelope)

Description

Laser interstitial thermal therapy (LITT) is MRI-guided thermal ablation of a target tissue with laser heat, delivered through a laser fiber placed in the brain along a stereotactic path. The procedure uses preprocedural stereotactic MRI, general anaesthesia, MRI-compatible head fixation and navigation, and a burr hole with a stereotactic bolt through which the probe is placed. The laser is then activated while real-time MRI monitoring maps the temperature around the fiber as thermal isodose lines. Two commercial platforms differ in their delivery: Visualase delivers continuous 980 nm laser energy through a saline-cooled diffusing fiber, and NeuroBlate delivers pulsed 1064 nm energy through a CO2-cooled side-firing or diffusing probe. The temperature reached sets the tissue outcome. Apoptosis begins around 45 °C. Irreversible coagulation occurs from 45 to 90 °C. Necrosis through protein denaturation sets in around 52 °C and extends across 50 to 80 °C. Above 100 °C a cavity forms. Histologically, the heated volume grades outward from central coagulation through edema to normal tissue.

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