MRI-Guided Stereotactic Laser Ablation

MRI-guided laser interstitial thermal therapy (MRgLITT), also referred to as stereotactic laser ablation (SLA), is a minimally invasive treatment modality for creating precise thermal ablations of pathological tissue such as in brain. Advances in laser probe design, MRI-based thermal imaging, also referred to as MR thermography, and stereotactic neuronavigation have culminated in the commercialization of intracranial SLA platforms for neurosurgery. Laser energy is delivered via an optical fiber into target tissue where it is converted to thermal energy, inducing cellular injury. The extent of thermal damage is guided by real-time MR thermography. SLA is an attractive alternative to open surgery and is suitable for a variety of brain pathologies necessitating tissue destruction or disconnection. Typical applications include epileptogenic lesions (such as mesial temporal sclerosis, hypothalamic hamartomas, and cortical dysplasias), neoplasms (such as metastatic brain tumors and difficult to access gliomas), and symptomatic postradiation necrosis. Basic concepts, surgical indications, planning, workflow, and outcomes are reviewed in this chapter. Despite recent proliferation of this approach, additional clinical studies are needed.