Contemporary Applications of Laser Interstitial Thermal Therapy: A Comprehensive Systematic Review

Abstract

Laser interstitial thermal therapy (LITT) is a minimally invasive modality for addressing intracranial pathology. LITT is recognized as a primary therapeutic option for a range of intracranial pathologies, particularly in inaccessible lesions. In the present study, we systematically review the evidentiary base supporting contemporary applications of LITT. Three databases were queried according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to identify studies presenting primary data on contemporary applications of LITT. Studies were screened to determine eligibility according to predefined eligibility criteria. Thirty-nine studies featuring 1533 patients were included. Across all uses, including treatment of brain tumors, radiation necrosis (RN), mesial temporal lobe epilepsy (MTLE), epilepsy secondary to hypothalamic hamartomas, and cavernous malformations, LITT is safe and efficacious, especially in patients who are ineligible for or not amenable to craniotomy. LITT is particularly useful in treating recurrent brain metastases and glioblastomas, with an increased overall survival in the latter of up to 26 months. In the management of RN (pseudo-progression), studies show faster steroid cessation in patients treated with LITT compared to medical management while also pre-empting the need for open craniotomy and stereotactic biopsy in the workup of suspected recurrence. In MTLE, LITT offers comparable rates of seizure freedom and reduction compared to anterior temporal lobectomy with potentially improved neuropsychiatric outcomes. LITT is an advantageous option for treating brain tumors, RN, and MTLE, among other pathologies. Continued investigation in emerging LITT applications can help clinicians expand the use of magnetic resonance imaging-guided stereotactic laser ablation technology into the treatment of a broad spectrum of central nervous system pathologies.

Keywords: Glioblastoma; Glioma; LITT; Laser interstitial thermal therapy; MTLE; Minimally invasive; Neurosurgery; Radiation necrosis.