1159 Magnetic Resonance-Guided Laser Interstitial Thermal Therapy (MRgLITT) Compared With Resective Surgery in Pediatric Patients With Refractory Epilepsy: Indications, Outcomes, and Considerations

INTRODUCTION: Epilepsy affects up to 0.5% of children, with one-third considered for surgery due to medical refractoriness. Studies show surgery offers better seizure freedom for drug-resistant epilepsy than medical therapy. However, it is underutilized due to potential complications and postoperative deficits, which have improved over time. This study evaluates the indications for MRgLITT compared to resective procedures and assesses perioperative variables, including seizure outcomes, in pediatric patients undergoing MRgLITT. We report the indications and outcomes, providing a statistical comparison to resective surgery. METHODS: All patients (n = 675) undergoing operative interventions for epilepsy from The Pediatric Epilepsy Research Consortium (PERC) were included. Using Chi-squared and Mann-Whitney-Wilcoxon tests, all available patient variables were compared between MRgLITT (n = 141) and open surgery (n = 534). All putative variables were included in multivariable logistic regression to identify independent predictors of seizure freedom. RESULTS: Patients undergoing MRgLITT were older at referral and surgery, had longer times to surgery, and more failed anti-seizure medications (ASMs), with no differences in race or insurance type compared to resective surgery patients. MRgLITT patients also had distinct etiologies, hemispheric involvement, operative locations, and higher use of invasive monitoring. Seizure freedom was achieved in 50% of MRgLITT patients versus 64% in resective surgery patients (p < 0.001). Fewer failed ASMs was the only independent predictor of postoperative seizure freedom (OR = 1.16, p = 0.012). While MRgLITT showed worse odds of seizure freedom in univariable analysis, it had equivalent outcomes to resective surgery in multivariable analysis. CONCLUSIONS: Given differences in patient variables, indications, and outcomes, MRgLITT has a distinct role in pediatric epilepsy surgery for select patients. Identified factors should guide patient selection/counseling. Prognosticating outcomes for MRgLITT patients is limited by the heterogeneous population, warranting further investigation.