Laser Interstitial Thermal Therapy (LITT)

Laser Ablation, Thermal Ablation

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Laser interstitial thermal therapy (LITT) is a minimally invasive surgical technique that uses a small laser to destroy unhealthy brain tissue. It can be an effective treatment option for recurrent brain tumors, radiation necrosis, and tumors that form deep within the brain. It is also used to treat certain types of epilepsy. Duke is among the top institutions for the number of LITT procedures performed each year in the U.S.

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About LITT

Also called laser ablation or thermal ablation, LITT provides the benefits of traditional brain surgery with less risk and a shorter recovery time. Because the procedure is minimally invasive, it is especially appropriate if you have undergone prior surgery or radiation or if you have a health condition that increases your risk with traditional brain surgery.

Conditions Treated with LITT

Primary Brain Tumors or Metastatic Brain Tumors 
Your neurosurgeon may recommend LITT if you have been diagnosed with a brain tumor that:

  • Returned after surgery or radiation therapy
  • Is deep within the brain and may otherwise be inoperable
  • Is smaller than three centimeters 

Radiation Necrosis
Radiation necrosis is a side effect that can occur months or years after radiation therapy for a brain tumor. It is a form of inflammation that can cause permanent loss of brain tissue. It can be difficult to differentiate between radiation necrosis and a recurrent tumor. 

LITT may be recommended if you are diagnosed with seizures that:

  • Are resistant to medications
  • Originate from a well-identified area in the brain

Evaluation for LITT Surgery

If a brain tumor is suspected, your doctor may order imaging scans to determine whether LITT is the best option for you. People with epilepsy will go through an epilepsy-specific surgical evaluation process.

In both cases, you will undergo an MRI, which will be used during the LITT procedure to map your brain. You may also complete a pre-anesthesia assessment to ensure you are healthy enough for surgery.

Duke University Hospital

LITT surgery is performed at Duke University Hospital. Duke clinics offer care before and after surgery.

LITT Surgery – What to Expect

LITT surgery usually takes about three to four hours.

Anesthesia and First Steps

After you are given anesthesia and are asleep, a neurosurgeon will make a tiny incision in your scalp and drill a small hole (about the diameter of a pencil) through the skull. 

Biopsy Performed When Treating a Brain Tumor

Since it can be difficult to differentiate between radiation necrosis and a brain tumor on MRI scans, Duke surgeons always perform a biopsy as part of the LITT procedure. Your neurosurgeon will use targeting technology and computer guidance to remove a small piece of tissue from the target area. The tissue sample will be evaluated by a pathologist, who will determine whether it is cancerous or benign. This is called a biopsy. A biopsy is not required when LITT surgery is used to treat epilepsy.

Laser Ablation

Your neurosurgeon will carefully guide the laser to protect healthy brain tissue. The laser will use heat to damage the unhealthy brain tissue, and live MRI mapping will monitor temperatures within the part of the brain being treated. Laser ablation can take from five minutes to an hour, depending on the size and shape of the target.

Final Steps

The neurosurgeon will close the incision, and you will be moved to a recovery area. Most people need to stay in the hospital overnight, but in some cases, you may go home the same day. Pain is typically minimal and can be managed with over-the-counter pain medications. You will need to limit strenuous activity for about two weeks after surgery.

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Why Choose Duke

Team of Experts
A large team of experts are involved in LITT evaluation and surgery including neurosurgeons, medical oncologists, radiation oncologists, neurologists, epileptologists, anesthesiologists, radiologists, and more. This thoughtful approach and collaboration results in thorough care and better outcomes.

Highly Experienced Team
Duke was an early adopter of the LITT procedure, and our neurosurgeons have been recognized for the high number of LITT procedures they perform each year. Research shows that hospitals and surgeons who perform more surgeries tend to have better outcomes. As an academic teaching hospital, we rely on our extensive experience performing LITT when training surgeons.

Patient Navigators Guide Your Care
Our patient navigators, some of whom are nurses, and care coordinators guide you and your loved ones through the complexities of receiving care from multiple specialists. Often, more than one appointment can be scheduled on the same day, for your convenience. The patient navigator can also help you access comprehensive support services available at Duke.

Research Leader
Duke researchers are always studying how to improve LITT technology. As a Duke patient, you may be eligible to participate in clinical trials that would give you access to the latest breakthroughs before they are available elsewhere.

Best Hospital for Neurology, Neurosurgery in NC

Where you receive your care matters. Duke University Hospital is proud of our team and the exceptional care they provide. They are why our neurology and neurosurgery program is nationally ranked, and the highest-ranked program in North Carolina by U.S. News & World Report for 2023–2024.

This page was medically reviewed on 03/20/2023 by