BACKGROUND: Pediatric low-grade gliomas (LGGs) account for approximately half of 
all pediatric central nervous system tumors. The low-grade gliomas' first line 
of treatment is gross total resection. However, when gross total resection is 
not possible, options for adjuvant therapy are limited. MRI-guided laser 
ablation (magnetic resonance-guided laser interstitial thermal therapy 
(MRgLITT)) offers a new option for treatment in selected cases. We present a 
description of the current MRgLITT technology and an exemplary case-series 
review of our experience in its use in LGGs.
CASE DESCRIPTION: A 19-month-old male was referred to the pediatric neurosurgery 
clinic with an incidental left temporal lesion discovered on a prenatal 
ultrasound. An MRI of the brain revealed a diffuse mesial temporal lesion. 
Electroencephalogram (EEG) showed generalized activity arising from the lesion. 
The patient underwent a navigation-guided biopsy then, two bolts were secured to 
the skull, and laser ablation was performed with intraoperative MR guidance. 
Pathology was consistent with ganglioglioma. Follow-up images 13 months after 
ablation showed a significant volumetric reduction in size of the tumor.
DISCUSSION: It is important to achieve maximal resection of low-grade gliomas in 
children, lessening the need for adjuvant chemotherapy and radiotherapy, while 
minimizing the length of hospital stay and disruption to the child's life. Of 
our nine LGGs patients treated with this technology, six had undergone previous 
surgery and MRgLITT proved itself to be a safe surgical treatment option to 
achieve further cytoreduction. While most of the cases are pilocytic 
astrocytomas, the location of the tumors was surgically challenging. Eight of 
the nine cases required a single trajectory-laser-while our case example 
requires two lasers. Only a case of a midbrain-thalamic tumor presented a 
post-ablation significant brain edema as perioperative complication [1]. Eight 
of the nine tumors did not require any coadjuvant therapy or further surgical 
treatment to date.
CONCLUSION: MRIgLITT is a successful option for treatment for selected de novo 
or recurrent low-grade gliomas in children. It can be combined with other 
therapies offering the advantages of a minimally invasive procedure. LITT may be 
added to the current pediatric neuro-oncology protocols, but larger prospective 
series are needed to show the effectiveness of LITT and to standardize 
indications and protocols.