Laser interstitial thermal therapy (LITT) - MRI-guided ablation of deep brain lesions.

LITT is a minimally invasive neurosurgical procedure in which a thin laser fibre is placed into a brain lesion through a 3–4 mm burr hole and used to heat and destroy the tissue from the inside. Real-time MRI thermometry monitors the temperature at the target and at nearby critical structures throughout, which is what makes ablation of deep or eloquent lesions viable.

LITT is a specialist service in a small number of UK centres - King’s College Hospital and the National Hospital for Neurology and Neurosurgery (Queen Square, UCLH) for adults, and Great Ormond Street for children. It is not offered in every neurosurgical unit, so most patients are referred in from elsewhere.

The main indications are deep-seated brain tumours (recurrent glioma, brain metastases), symptomatic radiation necrosis after Gamma Knife or fractionated radiotherapy, drug-resistant mesial temporal lobe epilepsy, hypothalamic hamartoma causing gelastic seizures, small focal cortical dysplasias in eloquent locations, and select deep cavernous malformations.

LITT is much less invasive - a single burr hole rather than a bone flap, a shorter hospital stay, and a quicker return to normal activity. The trade-off is that it works best for small, well-defined lesions, and for some larger or more accessible tumours an open resection still gives better tumour control.

For mesial temporal sclerosis, published series report seizure freedom of around 60–70% at twelve months after LITT, modestly lower than the 70–80% typically quoted for open anterior temporal lobectomy. The advantage of LITT is a smaller impact on verbal memory and a much quicker recovery, which is why many epilepsy centres now discuss both options.

Gamma Knife is non-invasive - no incision at all - and is often the first choice for small brain metastases. LITT is preferred when a lesion has already been irradiated and needs a different modality (for example, biopsy-proven radiation necrosis, or a recurrence within a previously treated field) or when a tissue diagnosis is needed at the same time.

The main risks are a small bleed along the fibre track (roughly 2–5%, most without symptoms), a transient neurological deficit that usually settles, and a permanent deficit in around 2–5% - the level of risk depends on how eloquent the treated area is. Post-procedure oedema managed with steroids, short-term seizures and, rarely, infection or CSF leak are the other things to know about.

LITT is overwhelmingly delivered through NHS specialist centres in the UK - the equipment, MR thermometry and MDT infrastructure needed are concentrated there. A small number of cases are funded privately by arrangement with those same centres, but a straight private price list is not the norm. We help you understand which route applies to your case.

Most patients are home in one to two days, back to office work in two to four weeks, and back to full activity by six to eight weeks. Driving is governed by DVLA rules - typically a minimum of four weeks off driving after cranial surgery, and much longer (often a year or more) if there is a seizure history. Your neurosurgical team confirms the exact rule for your case.