Staged laser interstitial thermal therapy and topectomy for complete obliteration of complex focal cortical dysplasias

• LITT may serve as an adjunct to open surgery.
• Staged LITT and topectomy may enable obliteration of complex cortical dysplasias.
• Obliteration of complex cortical dysplasias may result in seizure freedom.

Anatomically complex focal cortical dysplasias may present significant challenges to safe and complete surgical resection via standard operative corridors. Laser interstitial thermal therapy (LITT) is an emerging minimally invasive technique that may address some of these challenges, enabling stereotactic ablation of deep and/or surgically inaccessible regions. However, complete ablation may not be feasible in all cases. To address this dilemma, we have designed a protocol utilizing staged LITT followed by topectomy to effect complete obliteration of a complex focal cortical dysplasia. The approach presented demonstrates the feasibility, safety, and clinical utility of combining laser ablation and open surgery for the definitive management of this lesion.