Treating a deep brain lesion without opening the skull. Laser interstitial thermal therapy (LITT) destroys pathological tissue through a 4 mm incision, with real-time thermal control by intraoperative MRI. A minimally invasive alternative to craniotomy in selected cases.
Laser interstitial thermal therapy (LITT) is a minimally invasive procedure that destroys a brain lesion using a laser probe inserted stereotactically to the target. The procedure is carried out within an intraoperative MRI system that measures tissue temperature in real time and halts the application if it exits the safe range, protecting the surrounding healthy tissue.
Unlike craniotomy, it does not require opening the skull: a 4 mm incision, minimal hair shaving and a single suture are sufficient. The laser energy travels through an optical fibre to the tip of the catheter, where it heats the pathological tissue until controlled necrosis occurs.
The Visualase™ system is authorised in Europe for the ablation of intracranial soft tissues in cranial neurosurgery. Its use is reserved for selected cases, especially when the lesion is deep, surrounded by eloquent areas or the patient is not a candidate for craniotomy.
Deep gliomas or in hard-to-access locations, recurrent lesions after surgery or radiosurgery, single brain metastases not resectable by open approach.
Symptomatic radionecrosis after stereotactic radiosurgery, especially when the associated oedema is refractory to corticosteroids.
Mesial temporal sclerosis, focal cortical dysplasias and other well-delimited epileptogenic lesions in patients who have failed two or more antiepileptic drugs.
A common cause of gelastic seizures and early development. LITT allows disconnection of the hamartoma without the morbidity of a deep microsurgical approach.
The valid comparison is always against the alternative that would have been offered: in lesions where craniotomy is feasible, LITT does not automatically replace it. But when the case allows, the impact on the patient is very different.
| Aspect | LITT | Open craniotomy |
|---|---|---|
| Incision | ~ 4 mm | Several centimetres, requires cranial opening |
| Hospital stay | Typical: 1-2 days1-8 | Typical: 4-5 days |
| Hair shaving | Minimal, not cosmetically significant | Extensive, depending on approach |
| Visible scar | Virtually none | Yes, in the cranial area |
| Infection risk | Reduced9,10 | Higher due to bone opening |
| Intraoperative control | Real-time temperature by MRI | Direct visualisation under microscope |
The comparison is indicative: each case requires individual assessment of the expected oncological, functional and vital benefit.
Most patients are discharged within 24 to 48 hours after the procedure1-8. Return to normal activity is typically faster than after an equivalent craniotomy.
Minimal shaving and an incision closed with one or two sutures, leaving no visible scar afterwards. An important consideration for many patients and their social reintegration.
The absence of bone opening reduces the risk of postoperative infectious complications compared to open approaches9,10.
In recurrent brain metastases after radiosurgery, published studies report resolution or reduction of symptoms in approximately 71 % of treated patients13.
Important. LITT does not replace craniotomy in all cases. The decision depends on the size, location and nature of the lesion, the patient's condition and therapeutic goals. Every indication is discussed in a multidisciplinary committee and contrasted with available alternatives. This page provides information but does not replace consultation with your medical team.
Review in a multidisciplinary committee (neurosurgery, neurology, oncology, radiology) to confirm that laser surgery offers the best benefit/risk ratio against microsurgery or radiosurgery.
Fusion of structural MRI, functional MRI (language, motor) and DTI tractography to calculate the safest trajectory, avoiding vessels and eloquent tracts.
Punctual incision (3-5 mm), stereotactic introduction of the laser fibre to the lesion under neuronavigation.
Application of laser energy with real-time thermal monitoring via intraoperative MRI. The system automatically calculates and halts the application if the temperature exits the safe range.
Removal of the fibre and closure with a single suture. Immediate postoperative MRI to document the ablated area. Typical discharge within 24-48 h.
MRI-guided laser interstitial ablation requires specific training in stereotactic neurosurgery and intraoperative image management. At Brain & Spine Barcelona, LITT is performed by Dr. Pedro Roldán.
Indicates and performs MRI-guided laser ablation (LITT) at Brain & Spine Barcelona. Experience in stereotactic surgery, functional neurosurgery and minimally invasive approaches to the nervous system.
View full profile →"I arrived with a glioma I had been told was inoperable. Here they reviewed it at the tumour board and offered me a plan. The surgery was a success. Four years on, I am well."
"For years I had a cervical disc herniation, operated on by another team with no improvement. Minimally invasive surgery gave me back my mobility and took the pain away."
"I travelled from outside Spain. The team reviewed my case before I came and gave me a clear plan. Caring people and impeccable technique."
If you have a brain tumour, a well-delimited epileptogenic lesion or a recurrence after radiosurgery, we can assess your case in a multidisciplinary committee and advise whether MRI-guided laser ablation is a reasonable alternative for you.