Surgeon reviews real-time imaging during laser interstitial thermal therapy (LITT) epilepsy surgery
Neurology & Neurosurgery

Laser Interstitial Thermal Therapy (LITT) Video: A New Approach to Epilepsy Surgery

On Medicine

A minimally invasive laser procedure can treat heard-to-reach seizure sites while reducing recovery time and limiting effects on surrounding brain tissue.

Feb. 4, 2022
Eden McCleskey

Article Highlights

  • Laser interstitial thermal therapy (LITT) enables precise ablation of epileptogenic tissue (e.g., hippocampus, amygdala) via a stereotactically placed probe, reducing the need for open craniotomy and limiting disruption to surrounding brain structures.
  • The combination of intraoperative CT (O-arm), MRI fusion, and ROSA robotic guidance allows for millimeter- to submillimeter-level precision in trajectory planning and probe placement, improving targeting reliability in deep brain structures.
  • Continuous intraoperative MRI monitoring enables visualization of tissue heating and thermal injury progression (e.g., reversible vs. irreversible zones), allowing clinicians to titrate energy delivery and optimize lesion size while minimizing collateral damage.
  • Compared to traditional surgical approaches, LITT is associated with shorter hospital stays (typically 1–2 nights) and faster return to baseline functional status, reflecting its less invasive nature and reduced tissue trauma.
  • In this case, successful targeting and ablation resulted in sustained seizure freedom at follow-up, reinforcing LITT as a viable therapeutic option for patients with medically intractable epilepsy.

MR-guided laser interstitial thermal therapy (LITT) is an emerging surgical technique that allows for the minimally invasive destruction of pathological soft tissue for a variety of central nervous system lesions ranging from brain tumors to epilepsy foci.

In the past decade, enhanced technologies, such as MRI thermometry and improved laser probe design, have opened up a new avenue of treatment for patients with lesions that would have previously been deemed too difficult to treat using conventional open craniotomy surgery. Since only a tiny hole is required, damage to cortical areas is minimized or avoided completely, even with deep lesions located near eloquent or vital areas of the brain.

“Here at Houston Methodist, we feel very fortunate to have the facilities, expertise and full suite of technologies to be able to offer laser surgery for epilepsy to our patients.”

Dr. Todd Trask
Houston Methodist neurosurgeon

See laser interstitial thermal therapy in action

In this video, Houston Methodist neurosurgeon Dr. Todd Trask and the surgical team use LITT to treat a 28-year-old patient with medically intractable epilepsy, offering an inside look at how modern operating rooms combine multiple cutting-edge technologies to revolutionize brain surgery options.

"To access this part of the brain with conventional surgery would have caused trauma and damage to the surrounding brain tissue," says Dr. Trask. "Laser interstitial thermal therapy allows us to avoid that, and as a bonus, recovery is faster, easier and the patient doesn't have a large visible scar along the scalp."

Follow along as Dr. Trask performs and narrates key tasks from the procedure, such as layering multiple imaging modalities, fixating the patient in space, placing the catheter, firing the laser and using real-time imaging to confirm results.

MRI thermometry enhances safety

"The MRI detects the temperature of the tissue and the computer algorithm displays that to us visually," Dr. Trask explains. "The yellow area indicates tissue damage that is occurring that is not yet irreversible, and the blue area shows tissue that is now dead. We can also monitor the temperature of the surrounding tissue and see that those areas are fine, the heat from the laser is not seeping out of the area where we want it."

Once the laser ablation surgery is complete, the patient stays in the hospital for one to two days and can resume normal activities in one to two weeks.

"I am happy to report the patient has been out of surgery for months now without any seizures," Dr. Trask says.

Jump to Transcript
Feb. 4, 2022
Eden McCleskey
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Transcript

00:00–00:30
Hi, I'm Dr. Todd Trask, I'm one of the neurosurgeons here at Houston Methodist Hospital and one of my areas of subspecialization is in the surgical treatment of epilepsy. Today we're going to be treating a patient with the technology known as laser interstitial thermal therapy,


00:30–01:00
which is a relatively new, minimally invasive technique. The patient we will be treating is 28 years old. He's right handed. He's had medically intractable epilepsy for about seven years. So what we've done now is we've planned the case and we're able to use this planning to look at where the probe will go through the brain


01:00–01:30
and we can see where it will enter in the back of the head and then kind of go straight in to the target, which is in the part of the brain called the hippocampus. And this is called the O-arm, which is almost like a CT scanner that we can do interoperatively.


01:30–02:00
And that's going to allow us to identify where the bone fiducules are in the skull, and then that information will be loaded into the ROSA robot and we'll be able to merge that information with the patient's MRI. We're lucky to have this technology here, and some places without this technology would have to now take the patient down to radiology department and perform a CT scan there.


02:00–02:30
But this allows us to to avoid that step. We've taken the the intraoperative basically cat scan and we're super imposing that onto the MRI images and the ROSA robot does the calculation automatically. And now we're just checking to make sure that it in the appearance is satisfactory.


02:30–03:00
And so we can see the skin on the MRI and the skin on the CT scan appear to be completely perfectly superimposed. The next step in the procedure is to fixate the patient in space in this procedure, we're really looking for accuracy in the millimeter or even submillimeter range.


03:00–03:30
Maybe we can use the bovie a little bit. OK, so we need the robot. You have mineral oil? actually really sweet or something? You see that thing. Yes.


03:30–04:00
Would you say would be. five, 5.5 mm. Let me be a little bit less. I like to go through OK, so the driver, the driver.


04:00–04:30
OK, so it's in the bone. We all agree? Here we go, one, two, three. four, five, six, seven, eight.


04:30–05:00
So now we're going to spend some time getting the patient ready.


05:00–05:30
So now he's sliding the probe down, but that probe is going exactly where we made that path with that metal dialating rod.


05:30–06:00
And then this piece right here is actually what powers that robotic driver. So when he wants to move the probe this election, drag it out. So the laser has been inserted into the target and is attached to the Monteris robot, which will drive the laser in and out as we need.


06:00–06:30
And so now we're getting the initial, the patient is in the magnet and we're going to get our initial MRI to see hopefully that our laser will be in the proper position and then we can start the ablation process in order to get to this part of the brain surgically.


06:30–07:00
You know, there's a little bit more trauma or damage to the surrounding brain that is avoided with this technique, and it looks right on target. So here here we can see this is the bolt that we placed. It causes some artifact on the MRI scanner and here we can see the laser. And we can track it as it's going towards target.


07:00–07:30
It's entering the hippocampus there, and we've left the device the purpose of a little bit short of the actual target on purpose. So this is the the anchor in the amygdala here. And so the trajectory and everything looks exactly the way we wanted it. And patients are usually in the hospital like two nights and could probably get away with one night for some patients.


07:30–08:00
But generally speaking, they'll be in the hospital two nights and then they can resume normal activities, you know, very quickly, certainly within a couple of weeks. So do I look OK? Yeah. I think it's good, yeah, I think I'm very happy.


08:00–08:30
I think we can save one person. Yeah. Mm-Hmm. And so this is a little bit like driving a car you have to hit the gas pedal. OK, so we're already here. So we'll see on the screen the MRI can detect the temperature of the tissue


08:30–09:00
and the computer algorithms, you know, display that to us visually, and we should start to see some evidence of heating occurring in the tissue that we're seeking to destroy, and we're starting to see that already and see a little yellow area, which is indicating this is some tissue damage which is occurring.