Magnetic resonance-guided laser interstitial thermal therapy (MRgLITT) for paediatric intracranial cavernous malformations: case series and review of the literature.

PURPOSE: Microsurgical resection is the standard for treating intracranial cavernous malformations (CMs), but minimally invasive approaches are gaining popularity, particularly for deep-seated lesions and pediatric patients. Magnetic resonance-guided laser interstitial thermal therapy (MRgLITT) has emerged as a potential alternative to open surgery. This study aims to evaluate the safety and efficacy of MRgLITT for pediatric cavernomas and review existing literature.

METHODS

A systematic search of MEDLINE (PubMed), Scopus, Embase, and Cochrane databases using terms related to "LITT" and "cavernomas" identified studies reporting MRgLITT outcomes in pediatric patients. Data on demographics, symptoms, lesion characteristics, and outcomes were extracted. A combined database included cases from literature and four treated at our institution, Santobono-Pausilipon Children's Hospital of Naples.

RESULTS

Three studies with eight pediatric cases and four additional institutional cases were analyzed, totaling 12 patients. Outcomes for epilepsy were favorable: two patients achieved Engel class IA, one class IC, and one class II. No recurrences or hemorrhages occurred. Two patients experienced permanent complications-one with partial right superior quadrantanopia and another with unilateral hearing loss.

CONCLUSION

MRgLITT offers comparable outcomes to open surgery with reduced invasiveness, particularly for deep-seated lesions. Advances in thermal monitoring, neurophysiological monitoring, and functional MRI integration could further refine this approach, expanding its applications while minimizing complications in pediatric CMs.