Building a LITT Practice

Abstract

MRI thermometry-guided laser thermocoagulation (LITT) ablates pathologic tissue in the brain via a narrow approach corridor allowing otherwise surgically inaccessible targets to be reliably ablated with real-time feedback and allowing intracranial ablation to be performed with minimal invasiveness even for more accessible targets. This technique is a tour de force of neurosurgical technology requiring the coordination of institution-wide resources for success including the operating suite, anesthesiology, radiology, pathology, and inpatient and outpatient services. The return on this investment is high: in addition to profound surgical benefits for select patients, LITT offers shorter lengths of hospital stay, increased patient comfort and satisfaction, and decreased patient and caregiver stress. Making LITT available to those who can benefit from it requires coordinating diverse resources to build a successful practice.

This chapter focuses on the technical decisions that the LITT team must make to accomplish this with respect to anesthesia; head fixation, stereotactic trajectory determination, implementation, and confirmation; laser fixation to the skull; obtaining tissue specimen; intraoperative versus diagnostic MRI scanner for real-time thermometry; and the choice of laser thermocoagulation platform. Because the available technical solutions are constantly evolving, the authors seek to illustrate the range of solutions available to meet each of these needs focusing on our experience rather providing a comprehensive discussion of every possibility. Other aspects of building a successful LITT practice including reimbursement and patient referrals are both institution specific and common to developing many types of practices so are covered with less detail; we apologize in advance for the necessity of limiting this portion of the discussion to the United States and its basis in our own evolving practice.