LITT (Laser interstitial thermal therapy) is a stereotactic-guided minimally invasive ablating technique that involves generating high temperatures thus leading to tissue coagulation, necrosis, and cellular apoptosis (1-3). LITT was initially described by Brown et al in 1983, for the treatment of tumors (5). Later, Sugiyama et al described the utility of this modality in the management of deep-seated brain tumors (6). The concept of using heat energy to treat tumors has evolved to a precise and efficient means with advances in imaging and stereotactic technology. Several animal model experiments have demonstrated brain tissue coagulation without tissue vaporization (7-11). Advances in imaging techniques made it possible to accurately control the delivery and monitor the thermal injury to the surrounding normal brain parenchyma.
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The role of radiosurgery in brain metastasis has simplified the overall management of patients with brain metastasis with an improvement in overall survival and quality of life (24, 25). Despite the advances in planning and application of radiation therapy, its side effects cannot be overemphasized. There is a significant damage to surrounding normal brain parenchyma following radiation therapy, which is usually grouped as adverse radiation effects (AREs) (26-28). The incidence of AREs after SRS is low with a 1-year cumulative incidence of 13%-14% in the literature (29). In a heterogeneous group of SRS-treated cerebral metastases, the incidence of RN ranged between 1.4% and 24% (30-32). The huge variation in the incidence of AREs can be attributed to widely varied SRS protocols. Moreover, the risk of AREs increases with increasing size and volume of the tumor (28). Radiation necrosis (RN) is one of the AREs that is often difficult to manage because of the ambiguity in diagnosis and treatment
The role of radiosurgery in brain metastasis has simplified the overall management of patients with brain metastasis with an improvement in overall survival and quality of life (24, 25). Despite the advances in planning and application of radiation therapy, its side effects cannot be overemphasized. There is a significant damage to surrounding normal brain parenchyma following radiation therapy, which is usually grouped as adverse radiation effects (AREs) (26-28). The incidence of AREs after SRS is low with a 1-year cumulative incidence of 13%-14% in the literature (29). In a heterogeneous group of SRS-treated cerebral metastases, the incidence of RN ranged between 1.4% and 24% (30-32). The huge variation in the incidence of AREs can be attributed to widely varied SRS protocols. Moreover, the risk of AREs increases with increasing size and volume of the tumor (28). Radiation necrosis (RN) is one of the AREs that is often difficult to manage because of the ambiguity in diagnosis and treatment