MRI-GUIDED LASER INTERSTITIAL THERMAL THERAPY IN MODERN NEUROSURGERY: THERMAL DOSIMETRY, PATIENT SELECTION, NEURO- ONCOLOGICAL APPLICATIONS, AND PRECISION ABLATION FOR DRUG- RESISTANT EPILEPSY

Аннотация

Background. Magnetic resonance-guided laser interstitial thermal therapy (MRgLITT) has evolved from an experimental stereotactic technique into a clinically relevant minimally invasive neurosurgical platform. Its principal advantage is the combination of stereotactic targeting, controlled thermal ablation, and real-time magnetic resonance thermometry. Contemporary indications include deep  or  surgically  difficult  gliomas,  recurrent  glioblastoma,  progressive  brain  metastases  after stereotactic radiosurgery, radiation necrosis, mesial temporal lobe epilepsy, hypothalamic hamartoma, and selected pediatric epileptogenic or neoplastic lesions.
Materials and Methods. A structured narrative review was performed using clinical trials, prospective multicenter registries, institutional cohorts, and translational studies addressing MRgLITT in neuro-oncology and epilepsy surgery. Evidence available through August 2026 was analyzed. Particular attention was directed toward patient selection, stereotactic trajectory planning, thermal dose coverage,  lesion  geometry,  seizure  outcome,  tumor  control,  steroid  dependency,  neurological morbidity, quality of life, and the emerging biological effects of thermal ablation.
Results. The clinical effectiveness of MRgLITT is highly dependent on lesion geometry, anatomical location, thermal coverage, and disease phenotype. In recurrent and difficult-to-access high-grade  gliomas,  LITT  provides  cytoreduction  with  relatively  short  hospitalization  and  may facilitate  rapid  transition  to  adjuvant  treatment.  In  biopsy-proven  radiation  necrosis,  LITT  can simultaneously  establish  tissue  diagnosis  and  treat  the  responsible  lesion  while  permitting corticosteroid reduction. For mesial temporal lobe epilepsy, prospective contemporary data indicate approximately 58% Engel class I seizure freedom at two years, although open anterior temporal resection  retains  higher  average  long-term  seizure-freedom  rates. Ablation  of  the  amygdala, hippocampal head, parahippocampal region, and rhinal cortices is associated with better seizure outcomes  than  indiscriminate  posterior  extension.  Hypothalamic  hamartoma  represents  another particularly  suitable  indication  because  stereotactic  disconnection  can  be  achieved  with  limited surgical exposure.
Conclusion. MRgLITT should not be viewed as a smaller version of open resection. It represents a distinct stereotactic therapeutic paradigm in which treatment success depends on precise target selection, three-dimensional thermal coverage, avoidance of critical neurovascular structures, and disease-specific endpoint definition. Future development will likely integrate robotic trajectory planning, connectome-informed targeting, quantitative thermal modeling, and biologically rational combinations with systemic therapy.