BlueCross BlueShield of Tennessee Medical Policy Manual

MRI-guided Laser-induced Thermotherapy for Neurological Indications


Laser-induced thermal ablation is proposed as a minimally invasive surgical option for the treatment of neurological indications such as tumors or epilepsy. This technique uses light energy delivered through a fiberoptic catheter to targeted tissues. The light energy is converted to thermal energy in the tissues, which are damaged by the heat. The catheter used to deliver the energy to the target site has a built-in cooling system; thus, the thermal energy purportedly damages only the targeted tissues. The applicator is surgically installed under MRI guidance, and the lesion is treated using MRI guidance to ensure precise targeting of the thermal energy. Examples of FDA approved devices include NeuroBlate® and Visualase®. 




Evidence is insufficient to determine whether this technology works as well or better than alternative therapies, because no comparative studies are available. This technology’s effect on patient survival and quality of life is unknown and can best be addressed through comparative studies. Clinical trials are in progress at this time. However, comparative studies are not included in these trials.


American College of Radiology/American Society of Neuroradiology (2014) ACR_ASNR practice parameter for the performance of non-breast magnetic resonance imaging (MRI) guided procedures. Retrieved October 23, 2018 from 

Du, V.X., Gandhi, S.V., Rekate, H.L., & Mehta, A.D. (2017). Laser interstitial thermal therapy: a first line treatment for seizures due to hypothalamic hamartoma? Epilepsia, 58 (Suppl 2), 77-84. Abstract retrieved December 8, 2017 from PubMed database.

ECRI Institute. Product Brief. (2014, August) Visualase® Thermal Therapy System (Visualase, Inc.) for MRI-guided laser ablation for neurologic tumors. Retrieved October 23, 2018 from ECRI Institute. (18 abstracts and/or guidelines reviewed)

Hoppe, C., Witt, J.A., Helmstaedter, C., Gasser, T., Vatter, H., & Elger, C.E. (2017). Laser interstitial thermotherapy (LiTT) in epilepsy surgery. Seizure, 48, 45-52. Abstract retrieved December 8, 2017 from PubMed database.

Kang, J., Wu, C., Tracy, J., Lorenzo, M., Evans, J., Nei, M., et al. (2015). Laser interstitial thermal therapy for medically intractable mesial temporal lobe epilepsy. Epilepsia, 57 (2), 325-334.Abstract retrieved December 29, 2016 from PubMed database.

LaRiviere, M., and Gross, R. (2016). Stereotactic laser ablation for medically intractable epilepsy: the next generation of minimally invasive surgery. Frontiers in Surgery. Vol. 3, Article 64. (Level 2 evidence)

Lewis, E. C., Weil, A. G., Duchowny, M., Bhatia, S., Ragheb, J., & Miller, I. (2015). MR-guided laser interstitial thermal therapy for pediatric drug-resistant lesional epilepsy. Epilepsia, 56 (10), 1590-1598. Abstract retrieved January 27, 2016 from PubMed database.

Mohammadi, A. M., Hawasli, A. H., Schroeder, J. L., Laxton, A. W., Elson, P., et al. (2014). The role of laser interstitial thermal therapy in enhancing progression-free survival of difficult-to access high-grade gliomas: a multicenter study. Cancer Medicine, 3 (4), 971-979. (Level 3 evidence)

National Comprehensive Cancer Network. (2018, March). NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®). Central nervous system cancers (V1.2018). Retrieved October 23, 2018 from

Sun, X. R., Patel, N. V., & Danish, S. F. (2015). Tissue ablation dynamics during magnetic resonance-guided, laser-induced thermal therapy.  Neurosurgery, 77 (1), 51-58. Abstract retrieved January 27, 2016 from PubMed database.

Tatsui, C., Stafford, R., Li, J., Sellin, J., Amini, B., Rao, G., et al. (2015). Utilization of laser interstitial thermotherapy guided by real-time thermal MRI as an alternative to separation surgery in the management of spinal metastasis. Journal of Neurosurgery Spine. (4), 400-411. Abstract retrieved December 29, 2016 from PubMed database.

Torres-Reveron, J., Tomasiewicz, H., Shetty, A., Amankulor, N. & Chiang, V. (2013). Stereotactic laser induced thermotherapy (LITT): a novel treatment for brain lesions regrowing after radiosurgery. Journal of Neurooncology. 113 (3), 495-503.Abstract retrieved December 29, 2016 from PubMed database.

U. S. Food and Drug Administration. (2007, August). Center for Devices and Radiological Health. 510k Premarket Notification Database. K071328. Retrieved December 29, 2016 from http://www/fda/.gov.

U. S. Food and Drug Administration. (2013, April). Center for Devices and Radiological Health. 510k Premarket Notification Database. K120561. Retrieved December 29, 2016 from http://www/fda/.gov.




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