Laser interstitial thermal therapy in pediatric neurosurgery: a prospective nationwide study on indications, safety, and early outcomes

Purpose To evaluate indications, safety, and early outcomes of MRI-guided laser interstitial thermal therapy (LITT) in a nationwide prospective pediatric cohort and to assess the feasibility of same-session stereotactic biopsy. Methods All consecutive pediatric patients (≤ 18 years) undergoing LITT at the Danish national referral center between June 2021 and October 2025 were prospectively enrolled. Demographic, clinical, radiological, and surgical variables were recorded. Safety outcomes included intraoperative complications, neurological deficits, length of stay, and 30-day readmission. Seizure outcomes were assessed by Engel classification, and tumor response by follow-up MRI. Results A total of 27 children (mean age 12 years, range 2–18) underwent LITT, including 18 treated for drug-resistant epilepsy and 9 for tumor indications. Same-session stereotactic biopsy was performed in 10 patients without biopsy-related complications or interference with ablation. No intraoperative complications occurred. Transient neurological deficits were observed in 8 patients and persistent deficits in 3. Hospital stay was ≤ 2 days in 23 patients, and no 30-day readmissions occurred. Seizure freedom (Engel class I) was achieved in 71%, 63%, and 57% at 6, 12, and 24 months, respectively. In tumor patients (median follow-up 15 months), MRI showed tumor control in 4 of 5 cases. Conclusion In this nationwide prospective cohort of 27 consecutively treated children, LITT was associated with a favorable safety profile for both epilepsy and tumor indications. Same-session stereotactic biopsy was feasible and safe, supporting LITT as a minimally invasive option in selected pediatric patients.