# MRI-guided laser ablation for pediatric intracranial pathology: single center experience

## TL;DR

This study shows that MRI-guided laser ablation is a safe and effective treatment for various pediatric brain conditions, including epilepsy and tumors.

## Contribution

The study provides a comprehensive single-center experience on MRgLITT outcomes in a large pediatric cohort.

## Key findings

- MRgLITT had a 13.6% complication rate with 3.4% major complications in 88 pediatric patients.
- Epilepsy patients had a 51.5% ILAE 1 outcome, and 68% of tumor patients showed no recurrence.
- Seizure outcomes were comparable between lesional and non-lesional epilepsy groups despite higher reoperation rates in the latter.

## Abstract

This study evaluates the safety and efficacy of MR-guided laser interstitial thermal therapy (MRgLITT) in 88 consecutive pediatric patients involving lesional and non-lesional epilepsy, brain tumors, cavernous malformations, and other intracranial masses.

A retrospective case series was performed on pediatric patients who underwent MRgLITT by the senior author between 2016 and 2024. Demographic, intraoperative, and outcome data were analyzed.

Eighty-eight patients (47 males, mean age 14.0 years) were included. Indications comprised epilepsy (68 patients, 80 procedures), brain tumors (25 patients, 26 procedures), and cavernous malformations (8 patients, 8 procedures). Complications occurred in 12 of 88 patients (13.6%), including three major complications (3.4%). Among epilepsy patients, 35 of 68 (51.5%) achieved an ILAE 1 outcome. Among tumor patients, 17 of 25 (68%) had no recurrence at latest follow-up. CCM patients had favorable clinical courses; among those with follow-up MRI, 6 of 7 demonstrated no residual lesion. Seizure outcomes did not differ significantly between lesional and non-lesional epilepsy cohorts: ILAE 1 outcomes occurred in 28 of 49 (57.1%) lesional versus 7 of 19 (36.8%) non-lesional patients. Reoperation was more frequent in non-lesional patients (6 of 19, 31.6%), though ultimate outcomes were comparable (p = 0.17). On multivariable analysis, higher social vulnerability index predicted poorer seizure outcomes, highlighting the impact of social determinants on surgical results.

MRgLITT demonstrated favorable safety and indication-specific outcomes for pediatric epilepsy, tumors, and cavernous malformations in this single-surgeon series. These findings support its role as both a primary and adjuvant treatment in pediatric neurosurgery.

The online version contains supplementary material available at 10.1007/s00381-026-07133-y.