Magnetic resonance imaging-guided laser interstitial thermal therapy in mesial temporal lobe epilepsy: surgical technique and treatment outcomes

INTRODUCTION: Magnetic resonance imaging-guided laser interstitial thermal therapy (MRIgLITT) has emerged as a minimally invasive alternative to open surgical resection in the management of drug-resistant mesial temporal lobe epilepsy (MTLE). This review provides a focused overview of selective laser amygdalohippocampotomy (SLAH), with particular emphasis on its clinical applicability. The article is primarily addressed to clinicians involved in the management of epilepsy. STATE OF THE ART: SLAH has demonstrated favorable seizure outcomes, with approximately 50-60% of patients achieving Engel Class I status in many published series. However, seizure-freedom rates are generally lower than those reported for anterior temporal lobectomy (ATL) in comparable MTLE populations. Despite this, SLAH offers a more favorable safety profile, including reduced neurocognitive morbidity, particularly in memory and language domains, as well as a lower incidence of visual field deficits and perioperative complications. Advances in neuroimaging, stereotactic techniques, intracranial monitoring, and real-time thermal mapping have further enhanced procedural precision and safety. CLINICAL IMPLICATIONS: SLAH represents an important treatment option for patients with drug-resistant MTLE, particularly for those at increased risk of cognitive decline following open surgery or those preferring minimally invasive approaches. The procedure allows for targeted ablation with reduced surgical morbidity and may be repeated if necessary, supporting its role in individualized treatment strategies. FUTURE DIRECTIONS: Current evidence is predominantly based on retrospective studies and single-center experiences. Prospective, ideally comparative studies are needed to better define long-term seizure outcomes, durability of treatment effects, and optimal patient selection criteria. Further standardization of surgical techniques and outcome reporting will be essential to fully establish the role of SLAH in clinical practice.