MRI-Guided Laser Interstitial Thermal Therapy for Adult Epilepsy: Single-Center Outcomes

Overview

This single-center study evaluates MRI-guided laser interstitial thermal therapy (MRIgLITT) as a minimally invasive surgical option for drug-resistant focal epilepsy in adults. The technique allows precise ablation of epileptogenic zones with real-time thermal monitoring, showing promising seizure control and cognitive outcomes across various epilepsy etiologies.

Background

Epilepsy affects approximately 3% of the population, with about 30% developing drug-resistant epilepsy (DRE). Surgical intervention remains the most effective treatment for many DRE patients, especially those with focal epilepsies, which comprise around 60% of cases. MRIgLITT has emerged as a minimally invasive technique that enables targeted ablation of epileptogenic lesions under real-time MRI thermometry, minimizing damage to surrounding functional tissue. Despite its advantages, standardized indications and outcome predictors remain to be fully established.

Data Highlights

The study retrospectively analyzed all MRIgLITT procedures performed between 2019 and 2023, excluding patients with less than 6 months follow-up. Data collected included demographics, epilepsy characteristics, surgical parameters (number of fibers, ablation time, power, accuracy), complications, and seizure outcomes assessed by Engel Scale at multiple time points. Cognitive assessments were conducted preoperatively and at 3 and 12 months postoperatively using a standardized neuropsychological protocol and Reliable Change Index methodology.

Key Findings

• MRIgLITT enables precise, millimeter-scale ablation of epileptogenic zones with continuous thermal monitoring, reducing risk to adjacent eloquent brain areas.
• It is particularly indicated for focal epilepsies with concordant clinical, electrophysiological, and imaging data, including temporal lobe epilepsy with hippocampal sclerosis and hypothalamic hamartomas.
• In temporal lobe epilepsy, MRIgLITT is preferentially used in the dominant hemisphere to minimize cognitive impairment, reserving open surgery for other cases.
• The technique allows treatment of deep or difficult-to-access lesions and is often accepted by patients reluctant to undergo open surgery.
• Standardized surgical protocols tailored to pathology and lesion location improve safety and efficacy, including specific catheter types, ablation parameters, and safety monitoring points.
• Cognitive outcomes post-MRIgLITT show minimal decline, with some patients demonstrating stable or improved function, addressing a critical gap in prior literature.

Clinical Implications

MRIgLITT represents a valuable minimally invasive surgical option for adults with drug-resistant focal epilepsy, especially when lesions are deep-seated or near eloquent cortex. Careful patient selection based on comprehensive presurgical evaluation and adherence to standardized procedural protocols can optimize seizure control while preserving cognitive function. This technique expands the surgical armamentarium, offering an alternative for patients unwilling or unsuitable for open resective surgery.

Conclusion

MRIgLITT is a safe and effective minimally invasive treatment for selected adult patients with focal drug-resistant epilepsy, providing precise lesion ablation with real-time monitoring and favorable cognitive outcomes. Continued refinement of indications and procedural standardization will enhance its role in epilepsy surgery.

References

1. Epilepsy Prevalence and Surgery Outcomes References [24, 39, 46]
2. MRIgLITT Technique and Monitoring References [19, 22, 23, 33, 52]
3. Minimally Invasive Surgery Advantages References [1, 5, 7, 10, 27-29, 31, 36, 41, 44, 48, 53]
4. Engel Scale for Seizure Outcome Assessment [14]
5. Reliable Change Index for Cognitive Assessment [13]
6. Neuropsychological Evaluation Protocol [34]