Magnetic resonance imaging-guided laser interstitial thermal therapy for posterior fossa lesions: A systematic review with exploratory single-arm meta-analysis

Background: Laser interstitial thermal therapy (LITT) is an emerging, minimally invasive, magnetic resonance imaging (MRI)-guided ablative technique for deep-seated primary brain tumors, brain metastases, and radiation necrosis. Although supportive data exist for select supratentorial indications, its efficacy and safety profile in the posterior fossa remains uncertain. Methods: PubMed, Embase, Scopus, Google Scholar, and the Cochrane Library, including Cochrane Central Register of Controlled Trials, were searched for studies reporting outcomes of LITT in the posterior fossa. Heterogeneity was assessed using the I 2 statistic, and pooled estimates were calculated using a random-effects model. Results: Nine studies comprising 99 patients with 102 posterior fossa lesions were included in the study. Follow-up varied across studies, ranging from 3.5 to 31.2 months. Lesion-level local control was 79.3% (95% confidence interval [CI]: 57.1–91.6). In stratified analyses, local control was 82.4% (95% CI: 72.1–89.5) for neoplastic lesions and 88.4% (95% CI: 75.0–95.1) for brain metastases. At the patient level, 7.5% (95% CI: 3.4–15.7) required salvage local therapy. Safety outcomes were as follows: persistent neurologic deficit 10.1% (95% CI: 5.4–18.3); all-cause mortality 8.3% (95% CI: 3.3–19.4); and procedure-related mortality 1.0% (95% CI: 0.1–6.8). Conclusion: In patients with posterior fossa lesions, LITT may provide meaningful lesion-level local control with an acceptable safety profile. Given the limited and heterogeneous evidence, these pooled estimates should be interpreted as exploratory rather than definitive. Selective use in surgically complex or treatment-refractory cases following multidisciplinary evaluation may be reasonable. Prospective multicenter studies with standardized endpoints and longer follow-up are needed to establish durability and refine indications.