Clinical outcomes and learning curve of MRgLITT system for drug‐resistant epilepsy in China: A single‐center retrospective study

Objective Magnetic resonance‐guided laser interstitial thermal therapy (MRgLITT) is a minimally invasive technique that allows for real‐time magnetic resonance imaging (MRI) monitoring and precise ablation of epileptogenic lesions. This study reports our initial clinical experience with a domestically developed MRgLITT system in patients with drug‐resistant epilepsy (DRE) and evaluates its efficacy, safety, and learning curve. Methods We retrospectively reviewed 36 patients with focal DRE who underwent MRgLITT between October 2020 and May 2021. Clinical characteristics, operative variables, ablation rate, and length of hospital stay were analyzed. Prognostic factors were examined using univariate and Kaplan–Meier survival analyses. The surgical learning curve was evaluated using cumulative sum (CUSUM) analysis of the operative time. Results The mean follow‐up duration was 40.86 months. At the last follow‐up, 66.7% patients (24/36) achieved seizure freedom (ILAE I–II), and the overall response rate (ILAE I–IV) was 94.4% (34/36). Single lesion ( p = 0.002) and ablation rate of ≥90% ( p = 0.009) were significant predictors of seizure freedom. CUSUM analysis identified a turning point in the 19th case, after which the operative time and total hospitalization, particularly the preoperative evaluation time, were significantly reduced. However, the ablation rate and seizure outcomes remained stable across phases. No long‐term postoperative complications were observed. Significance MRgLITT is safe and effective in patients with DRE, and adequate ablation and well‐localized single lesions predict a higher likelihood of favorable outcomes. We present the first evaluation of the MRgLITT learning curve in China and confirm that the technique can be readily adopted with consistent clinical outcomes. Plain Language Summary This study assessed the use of a domestic MRgLITT system of China in drug‐resistant epilepsy with more than 3 years of follow‐up. Seizure freedom was achieved in 66.7% of patients, and over 90% experienced significant improvement without long‐term complications. Single lesions and ablation rate above 90% predicted favorable outcomes. Surgical proficiency was reached after 19 cases, reflecting improved efficiency while maintaining stable efficacy and safety. MRgLITT is a safe, effective, and easily adoptable minimally invasive option for selected patients with drug‐resistant epilepsy.