{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T16:06:33Z","timestamp":1776096393054,"version":"3.50.1"},"reference-count":26,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"3","license":[{"start":{"date-parts":[[2026,1,19]],"date-time":"2026-01-19T00:00:00Z","timestamp":1768780800000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Neurosurg Case Lessons"],"published-print":{"date-parts":[[2026,1,19]]},"abstract":"\n BACKGROUND<\/jats:title>\n Responsive neurostimulation (RNS) enables real-time electrographic monitoring and chronic assessment of seizure burden in two distinct brain regions. Laser interstitial thermal therapy (LITT) offers a minimally invasive treatment for mesial temporal epilepsy. Unilateral LITT that maintains functional RNS contralaterally poses significant challenges. As RNS use becomes more widespread, adjunctive seizure reduction therapies following implantation may become increasingly common. The authors present 2 cases illustrating a minimally invasive surgical approach.<\/jats:p>\n <\/jats:sec>\n \n OBSERVATIONS<\/jats:title>\n Two patients with bitemporal RNS underwent long-term monitoring that revealed a significant unilateral predominance in seizure onset. LITT targeting the more active mesial temporal lobe while maintaining a functioning RNS contralaterally was recommended. Mesial temporal laser ablations were performed that accounted for existing RNS hardware and manufacturer-imposed MRI safety limitations. Both patients retained fully functional RNS systems postoperatively and experienced no complications. The laser ablations were technically successful with encouraging early seizure freedom outcomes. Long-term monitoring will determine sustained efficacy.<\/jats:p>\n <\/jats:sec>\n \n LESSONS<\/jats:title>\n LITT was safely performed in the prone position in 2 patients with preexisting RNS systems. Caution is required to avoid hardware damage or electrode overheating during MRI. While further study is needed to assess outcomes, this technique offers a promising option for patients requiring targeted ablation following extended RNS monitoring.<\/jats:p>\n \n https:\/\/thejns.org\/doi\/10.3171\/CASE25434<\/jats:ext-link>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/case25434","type":"journal-article","created":{"date-parts":[[2026,1,22]],"date-time":"2026-01-22T12:00:03Z","timestamp":1769083203000},"source":"Crossref","is-referenced-by-count":0,"title":["Laser interstitial thermal therapy with a previously implanted responsive neurostimulation device: a multicenter experience. Illustrative cases"],"prefix":"10.3171","volume":"11","author":[{"given":"Stephen","family":"Jaffee","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Allegheny Health Network Neuroscience Institute, Pittsburgh, Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1928-0167","authenticated-orcid":true,"given":"Jordan","family":"Iordanou","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Texas Southwestern Medical Center, Dallas, Texas"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Trent","family":"Kite","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Allegheny Health Network Neuroscience Institute, Pittsburgh, Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3634-406X","authenticated-orcid":true,"given":"Bradley","family":"Lega","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Texas Southwestern Medical Center, Dallas, Texas"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexander C.","family":"Whiting","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Allegheny Health Network Neuroscience Institute, Pittsburgh, Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"issue":"4","key":"bib1","series-title":"Epilepsia","first-page":"470","article-title":"Epileptic seizures and epilepsy: definitions proposed by the International League Against Epilepsy (ILAE) and the International Bureau for Epilepsy (IBE)","volume":"46","author":"Fisher","year":"2005","unstructured":"Fisher RSvan Emde Boas WBlume WEpileptic seizures and epilepsy: definitions proposed by the International League Against Epilepsy (ILAE) and the International Bureau for Epilepsy (IBE). Epilepsia. 2005;46(4):470-472."},{"issue":"6","key":"bib2","series-title":"Epilepsia","first-page":"1069","article-title":"Definition of drug resistant epilepsy: consensus proposal by the ad hoc Task Force of the ILAE Commission on Therapeutic Strategies","volume":"51","author":"Kwan","year":"2010","unstructured":"Kwan PArzimanoglou ABerg ATDefinition of drug resistant epilepsy: consensus proposal by the ad hoc Task Force of the ILAE Commission on Therapeutic Strategies. Epilepsia. 2010;51(6):1069-1077."},{"key":"bib3","series-title":"Epilepsy Res","first-page":"73","article-title":"Epileptic networks in patients with bitemporal epilepsy: the role of SEEG for the selection of good surgical candidates","volume":"128","author":"Di Vito","year":"2016","unstructured":"Di Vito LMaugui\u00e8re FCatenoix HEpileptic networks in patients with bitemporal epilepsy: the role of SEEG for the selection of good surgical candidates. Epilepsy Res. 2016;128:73-82."},{"issue":"8","key":"bib4","series-title":"Epilepsia","first-page":"2037","article-title":"Patient-specific structural connectivity informs outcomes of responsive neurostimulation for temporal lobe epilepsy","volume":"63","author":"Charlebois","year":"2022","unstructured":"Charlebois CMAnderson DNJohnson KAPatient-specific structural connectivity informs outcomes of responsive neurostimulation for temporal lobe epilepsy. Epilepsia. 2022;63(8):2037-2055."},{"issue":"3","key":"bib5","series-title":"Epilepsia","first-page":"432","article-title":"Two-year seizure reduction in adults with medically intractable partial onset epilepsy treated with responsive neurostimulation: final results of the RNS System Pivotal trial","volume":"55","author":"Heck","year":"2014","unstructured":"Heck CNKing-Stephens DMassey ADTwo-year seizure reduction in adults with medically intractable partial onset epilepsy treated with responsive neurostimulation: final results of the RNS System Pivotal trial. Epilepsia. 2014;55(3):432-441."},{"key":"bib6","series-title":"World Neurosurg","first-page":"e70","article-title":"Systematic review and meta-analysis of responsive neurostimulation in epilepsy","volume":"167","author":"Kusyk","year":"2022","unstructured":"Kusyk DMMeinert JStabingas KCYin YWhiting AC.Systematic review and meta-analysis of responsive neurostimulation in epilepsy. World Neurosurg. 2022;167:e70-e78."},{"key":"bib7","series-title":"Epilepsy Behav","first-page":"388","article-title":"Responsive neurostimulation: candidates and considerations","volume":"88","author":"Ma","year":"2018","unstructured":"Ma BBRao VR.Responsive neurostimulation: candidates and considerations. Epilepsy Behav. 2018;88:388-395."},{"issue":"9","key":"bib8","series-title":"Neurology","first-page":"e1244","article-title":"Nine-year prospective efficacy and safety of brain-responsive neurostimulation for focal epilepsy","volume":"95","author":"Nair","year":"2020","unstructured":"Nair DRLaxer KDWeber PBNine-year prospective efficacy and safety of brain-responsive neurostimulation for focal epilepsy. Neurology. 2020;95(9):e1244-e1256."},{"issue":"1","key":"bib9","series-title":"Commun Med (Lond)","first-page":"166","article-title":"Unearthing the mechanisms of responsive neurostimulation for epilepsy","volume":"3","author":"Rao","year":"2023","unstructured":"Rao VRRolston JD.Unearthing the mechanisms of responsive neurostimulation for epilepsy. Commun Med (Lond). 2023;3(1):166."},{"issue":"7","key":"bib10","series-title":"Epilepsia","first-page":"1421","article-title":"Laser ablation for mesial temporal lobe epilepsy: surgical and cognitive outcomes with and without mesial temporal sclerosis","volume":"59","author":"Donos","year":"018","unstructured":"Donos CBreier JFriedman ELaser ablation for mesial temporal lobe epilepsy: surgical and cognitive outcomes with and without mesial temporal sclerosis. Epilepsia. 018;59(7):1421-1432."},{"issue":"3","key":"bib11","series-title":"Ann Neurol","first-page":"575","article-title":"Stereotactic laser amygdalohippocampotomy for mesial temporal lobe epilepsy","volume":"83","author":"Gross","year":"2018","unstructured":"Gross REStern MAWillie JTStereotactic laser amygdalohippocampotomy for mesial temporal lobe epilepsy. Ann Neurol. 2018;83(3):575-587."},{"key":"bib12","series-title":"Seizure","first-page":"45","article-title":"Laser interstitial thermotherapy (LiTT) in epilepsy surgery","volume":"48","author":"Hoppe","year":"2017","unstructured":"Hoppe CWitt JAHelmstaedter CGasser TVatter HElger CE.Laser interstitial thermotherapy (LiTT) in epilepsy surgery. Seizure. 2017;48:45-52."},{"issue":"24","key":"bib13","series-title":"J Neurosurg Case Lessons","first-page":"CASE23590","article-title":"Stereoelectroencephalography in the setting of a previously implanted responsive neural stimulation device: illustrative case","volume":"6","author":"Kusyk","year":"2023","unstructured":"Kusyk DMBlaney NQuezada TWhiting AC.Stereoelectroencephalography in the setting of a previously implanted responsive neural stimulation device: illustrative case. J Neurosurg Case Lessons. 2023;6(24):CASE23590."},{"issue":"4","key":"bib1","series-title":"Epilepsia","first-page":"470","article-title":"Epileptic seizures and epilepsy: definitions proposed by the International League Against Epilepsy (ILAE) and the International Bureau for Epilepsy (IBE)","volume":"46","author":"Fisher","year":"2005","unstructured":"Fisher RSvan Emde Boas WBlume WEpileptic seizures and epilepsy: definitions proposed by the International League Against Epilepsy (ILAE) and the International Bureau for Epilepsy (IBE). Epilepsia. 2005;46(4):470-472."},{"issue":"6","key":"bib2","series-title":"Epilepsia","first-page":"1069","article-title":"Definition of drug resistant epilepsy: consensus proposal by the ad hoc Task Force of the ILAE Commission on Therapeutic Strategies","volume":"51","author":"Kwan","year":"2010","unstructured":"Kwan PArzimanoglou ABerg ATDefinition of drug resistant epilepsy: consensus proposal by the ad hoc Task Force of the ILAE Commission on Therapeutic Strategies. Epilepsia. 2010;51(6):1069-1077."},{"key":"bib3","series-title":"Epilepsy Res","first-page":"73","article-title":"Epileptic networks in patients with bitemporal epilepsy: the role of SEEG for the selection of good surgical candidates","volume":"128","author":"Di Vito","year":"2016","unstructured":"Di Vito LMaugui\u00e8re FCatenoix HEpileptic networks in patients with bitemporal epilepsy: the role of SEEG for the selection of good surgical candidates. Epilepsy Res. 2016;128:73-82."},{"issue":"8","key":"bib4","series-title":"Epilepsia","first-page":"2037","article-title":"Patient-specific structural connectivity informs outcomes of responsive neurostimulation for temporal lobe epilepsy","volume":"63","author":"Charlebois","year":"2022","unstructured":"Charlebois CMAnderson DNJohnson KAPatient-specific structural connectivity informs outcomes of responsive neurostimulation for temporal lobe epilepsy. Epilepsia. 2022;63(8):2037-2055."},{"issue":"3","key":"bib5","series-title":"Epilepsia","first-page":"432","article-title":"Two-year seizure reduction in adults with medically intractable partial onset epilepsy treated with responsive neurostimulation: final results of the RNS System Pivotal trial","volume":"55","author":"Heck","year":"2014","unstructured":"Heck CNKing-Stephens DMassey ADTwo-year seizure reduction in adults with medically intractable partial onset epilepsy treated with responsive neurostimulation: final results of the RNS System Pivotal trial. Epilepsia. 2014;55(3):432-441."},{"key":"bib6","series-title":"World Neurosurg","first-page":"e70","article-title":"Systematic review and meta-analysis of responsive neurostimulation in epilepsy","volume":"167","author":"Kusyk","year":"2022","unstructured":"Kusyk DMMeinert JStabingas KCYin YWhiting AC.Systematic review and meta-analysis of responsive neurostimulation in epilepsy. World Neurosurg. 2022;167:e70-e78."},{"key":"bib7","series-title":"Epilepsy Behav","first-page":"388","article-title":"Responsive neurostimulation: candidates and considerations","volume":"88","author":"Ma","year":"2018","unstructured":"Ma BBRao VR.Responsive neurostimulation: candidates and considerations. Epilepsy Behav. 2018;88:388-395."},{"issue":"9","key":"bib8","series-title":"Neurology","first-page":"e1244","article-title":"Nine-year prospective efficacy and safety of brain-responsive neurostimulation for focal epilepsy","volume":"95","author":"Nair","year":"2020","unstructured":"Nair DRLaxer KDWeber PBNine-year prospective efficacy and safety of brain-responsive neurostimulation for focal epilepsy. Neurology. 2020;95(9):e1244-e1256."},{"issue":"1","key":"bib9","series-title":"Commun Med (Lond)","first-page":"166","article-title":"Unearthing the mechanisms of responsive neurostimulation for epilepsy","volume":"3","author":"Rao","year":"2023","unstructured":"Rao VRRolston JD.Unearthing the mechanisms of responsive neurostimulation for epilepsy. Commun Med (Lond). 2023;3(1):166."},{"issue":"7","key":"bib10","series-title":"Epilepsia","first-page":"1421","article-title":"Laser ablation for mesial temporal lobe epilepsy: surgical and cognitive outcomes with and without mesial temporal sclerosis","volume":"59","author":"Donos","year":"018","unstructured":"Donos CBreier JFriedman ELaser ablation for mesial temporal lobe epilepsy: surgical and cognitive outcomes with and without mesial temporal sclerosis. Epilepsia. 018;59(7):1421-1432."},{"issue":"3","key":"bib11","series-title":"Ann Neurol","first-page":"575","article-title":"Stereotactic laser amygdalohippocampotomy for mesial temporal lobe epilepsy","volume":"83","author":"Gross","year":"2018","unstructured":"Gross REStern MAWillie JTStereotactic laser amygdalohippocampotomy for mesial temporal lobe epilepsy. Ann Neurol. 2018;83(3):575-587."},{"key":"bib12","series-title":"Seizure","first-page":"45","article-title":"Laser interstitial thermotherapy (LiTT) in epilepsy surgery","volume":"48","author":"Hoppe","year":"2017","unstructured":"Hoppe CWitt JAHelmstaedter CGasser TVatter HElger CE.Laser interstitial thermotherapy (LiTT) in epilepsy surgery. Seizure. 2017;48:45-52."},{"issue":"24","key":"bib13","series-title":"J Neurosurg Case Lessons","first-page":"CASE23590","article-title":"Stereoelectroencephalography in the setting of a previously implanted responsive neural stimulation device: illustrative case","volume":"6","author":"Kusyk","year":"2023","unstructured":"Kusyk DMBlaney NQuezada TWhiting AC.Stereoelectroencephalography in the setting of a previously implanted responsive neural stimulation device: illustrative case. 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