Laser Interstitial Thermal Therapy for Epilepsy

Magnetic resonance imaging-guided laser interstitial thermal therapy (LITT) has emerged as a minimally invasive alternative to open surgical resection for drug-resistant epilepsy, with increasing adoption in advanced epilepsy centers over the past decade. This review provides a comprehensive overview of LITT applications and outcomes in treating various epilepsy etiologies.

Stereotactic laser amygdalohippocampectomy (SLAH) via LITT for temporal lobe epilepsy achieves Engel Class 1 outcomes in 58% of patients, which is comparable to anterior temporal lobectomy, while demonstrating less neurocognitive morbidity and fewer visual field deficits. LITT has shown favorable seizure outcomes across multiple epilepsy etiologies, including corpus callosotomy, cavernous malformations, focal cortical dysplasia, and epilepsy associated tumors. The minimally invasive nature of LITT has expanded treatment options for lesions traditionally associated with significant operative morbidity, including hypothalamic hamartomas and periventricular nodular heterotopias.

While much of the current data consists of retrospective case series, there is growing evidence to support the use of LITT as an effective treatment option across diverse drug-resistant epilepsy indications. Its combination of acceptable seizure outcomes with reduced surgical morbidity positions LITT as a valuable tool in the epilepsy surgery armamentarium.