Laser Ablation (LITT)
Laser interstitial thermal therapy treats a small area of the brain from the inside, through an opening only a few millimeters wide. It is used for some forms of drug-resistant epilepsy, for selected brain tumors, and for radiation necrosis after radiosurgery. Here is how it works, what to expect, and how it compares with other options.
What Is LITT?
Laser interstitial thermal therapy (LITT), often called laser ablation, uses a thin laser fiber placed precisely into a target in the brain. The fiber gently heats the target from within, while an MRI scanner measures the temperature in real time so the treatment covers the intended area and spares the tissue around it.
How it works, in plain terms
- A thin fiber is guided to the target through a small opening in the skull, using stereotactic (3D navigation) planning. There is no large incision and the skull is not opened.
- The treatment is done inside an MRI scanner, which shows the heat spreading through the target as it happens.
- The procedure is usually done under general anesthesia.
- Most people stay in the hospital for about one night, and recovery is usually shorter than after open brain surgery.
Conditions Treated With LITT
LITT uses FDA-cleared laser systems. It is chosen for specific problems where treating a small, well-defined target from the inside can offer a gentler path than open surgery.
Drug-resistant epilepsy
When seizures start in a small, identifiable area of the brain, LITT can treat that area directly. Examples include mesial temporal lobe epilepsy (often with hippocampal sclerosis), hypothalamic hamartoma, and small lesions such as cavernous malformations or areas of cortical dysplasia. In many cases the seizure focus is first mapped with stereo-EEG (SEEG).
Selected brain tumors
LITT can treat tumors that are small or located deep in the brain, where open surgery would be riskier. This includes some brain metastases that grow again after radiosurgery and selected gliomas. A biopsy is often taken during the same procedure to confirm the diagnosis.
Radiation necrosis
After radiosurgery, a small number of people develop an area of inflamed, damaged tissue called radiation necrosis. It can cause swelling and symptoms, and on MRI it can look similar to tumor growth. When medications such as steroids are not enough or are not well tolerated, LITT can treat the area, and a biopsy at the same time can help tell necrosis apart from tumor.
Could LITT Be Right for Me?
Whether LITT is a good option depends on your diagnosis, the size and location of the target, and your overall health. A formal evaluation is the only way to know, but these general points help frame the conversation.
Often a good fit
- A small, well-defined target
- A target deep in the brain that is hard to reach with open surgery
- A wish to avoid a craniotomy or to recover faster
- Radiation necrosis or tumor regrowth after prior radiosurgery
May not be the best option
- A large tumor causing pressure that needs to be removed
- A target right next to structures that are sensitive to heat
- When a large tissue sample is needed for diagnosis
- When an MRI cannot be safely performed
Before, During, and After
Before: evaluation and planning
Your team reviews your MRI and, for epilepsy, your seizure evaluation (which may include SEEG). A precise path to the target is planned on the computer to avoid blood vessels and important brain areas.
During: placement and MRI-guided treatment
Under general anesthesia, the laser fiber is placed through a small opening in the skull. You are then moved into the MRI scanner, where the target is heated while the team watches the temperature map in real time. The fiber is removed at the end, and the small incision is closed with a stitch or two.
After: recovery and follow-up
Most people go home the next day. A short course of steroids is common to control swelling, and some symptoms can be temporarily worse while the swelling settles. Follow-up visits and MRI scans track how the treated area responds over time.
What It Can and Cannot Do
Benefits
- Small incision, with no craniotomy
- Usually a one-night hospital stay and a faster return to daily life
- Can reach deep targets that are difficult to operate on
- Can be combined with a biopsy in the same procedure
Important limits
- The treated tissue is not removed, so swelling can take time to settle
- Best suited to smaller targets
- For some types of epilepsy, open surgery may offer a higher chance of seizure freedom
- Possible risks include bleeding, swelling, and new neurological symptoms, depending on the location
Your team will discuss the specific benefits and risks for your situation, including how LITT compares with open surgery, radiosurgery, and neuromodulation, before you decide.
LITT and the Alternatives
There is often more than one reasonable way to treat epilepsy, a brain tumor, or radiation necrosis. Each approach has a different trade-off, and the best choice depends on you.
Laser ablation (LITT)
Best suited for: Small, well-defined targets, especially deep ones, when a gentler recovery matters. For epilepsy, LITT may help protect memory and language function compared with larger open operations in some locations.
Open surgery (resection)
Best suited for: Larger lesions, tumors causing pressure, or situations where removing tissue gives the best chance of seizure control or a full diagnosis. The trade-off is a larger operation and a longer recovery.
Radiosurgery (Gamma Knife)
Best suited for: Many brain tumors and some vascular lesions, with no incision at all. The effect develops gradually over months, and it is not usually the next step for radiation necrosis.
Neuromodulation (RNS, DBS, VNS)
Best suited for: Epilepsy when seizures start in more than one area, or in areas that cannot be safely treated or removed. These implanted devices reduce seizures by adjusting brain activity rather than treating a single spot.
Finding Out If It's Right for You
This page is general education, not medical advice. Deciding on LITT takes a personal evaluation of your diagnosis, imaging, prior treatment, and goals, weighing it alongside open surgery, radiosurgery, neuromodulation, and medication.
If you are living with drug-resistant epilepsy, a deep brain tumor, or radiation necrosis after radiosurgery, ask your doctor whether laser ablation is an option, or request an evaluation to compare your choices side by side.
This information is provided for general educational purposes and does not replace a consultation with a qualified physician. Candidacy and individual risks and benefits should be confirmed with your care team.