Seizure outcome of pediatric magnetic resonance-guided laser interstitial thermal therapy versus open surgery: A matched noninferiority cohort study

Omar Yossofzai, Scellig Stone, Joseph Madsen, Rahim Moineddin, Shelly Wang, John Ragheb, Ismail Mohamed, Robert Bollo, Dave Clarke, M. Scott Perry, Alexander G. Weil, Jeffrey Raskin, Jonathan Pindrik, Raheel Ahmed, Sandi Lam, Aria Fallah, Cassia Maniquis, Andrea Andrade, George M. Ibrahim, James DrakeJames Rutka, Jignesh Tailor, Nicholas Mitsakakis, Klajdi Puka, Elysa Widjaja*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

9 Scopus citations


Objective: Minimally invasive magnetic resonance-guided laser interstitial thermal therapy (MRgLITT) has been proposed as an alternative to open epilepsy surgery, to address concerns regarding the risk of open surgery. Our primary hypothesis was that seizure freedom at 1 year after MRgLITT is noninferior to open surgery in children with drug-resistant epilepsy (DRE). The secondary hypothesis was that MRgLITT has fewer complications and shorter hospitalization than surgery. The primary objective was to compare seizure outcome of MRgLITT to open surgery in children with DRE. The secondary objective was to compare complications and length of hospitalization of the two treatments. Methods: This retrospective multicenter cohort study included children with DRE treated with MRgLITT or open surgery with 1-year follow-up. Exclusion criteria were corpus callosotomy, neurostimulation, multilobar or hemispheric surgery, and lesion with maximal dimension > 60 mm. MRgLITT patients were propensity matched to open surgery patients. The primary outcome was seizure freedom at 1 year posttreatment. The difference in seizure freedom was compared using noninferiority test, with noninferiority margin of −10%. The secondary outcomes were complications and length of hospitalization. Results: One hundred eighty-five MRgLITT patients were matched to 185 open surgery patients. Seizure freedom at 1 year follow-up was observed in 89 of 185 (48.1%) MRgLITT and 114 of 185 (61.6%) open surgery patients (difference = −13.5%, one-sided 97.5% confidence interval = −23.8% to ∞, pNoninferiority =.79). The lower confidence interval boundary of −23.8% was below the prespecified noninferiority margin of −10%. Overall complications were lower in MRgLITT compared to open surgery (10.8% vs. 29.2%, respectively, p <.001). Hospitalization was shorter for MRgLITT than open surgery (3.1 ± 2.9 vs. 7.2 ± 6.1 days, p <.001). Significance: Seizure outcome of MRgLITT at 1 year posttreatment was inferior to open surgery. However, MRgLITT has the advantage of better safety profile and shorter hospitalization. The findings will help counsel children and parents on the benefits and risks of MRgLITT and contribute to informed decision-making on treatment options.

Original languageEnglish (US)
Pages (from-to)114-126
Number of pages13
Issue number1
StatePublished - Jan 2023


  • drug-resistant epilepsy
  • laser interstitial thermal therapy
  • pediatric epilepsy surgery
  • propensity score
  • seizure outcome

ASJC Scopus subject areas

  • Clinical Neurology
  • Neurology


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