Magnetic resonance-guided laser interstitial thermal therapy versus open surgical corpus callosotomy for pediatric refractory epilepsy: A systematic review and meta-analysis

•Corpus callosotomy is underutilized due to the potential complications.•However, MRgLITT mitigates the concerns associated with open surgery.•The minimally invasive approach is associated with lower hospital length of stay and complications.•It is also associated with a longer time of surgery and costs, reducing its widespread use.•No particular procedure is preferred and individualization of each case is needed. Magnetic resonance-guided laser interstitial thermal therapy (MRgLITT) is a novel, minimally invasive alternative to traditional open surgery corpus callosotomy (CC). We aim to compare both approaches in terms of time of hospitalization and surgical procedure, complications, and efficacy outcomes. A systematic search on PubMed, Embase, Web of Science, and Cochrane Library databases was performed for studies directly comparing MRgLITT and open surgery for refractory epilepsy in children. A total of 240 patients from five studies were included. There was no statistically significant difference observed between the two groups regarding the favorable Engel outcome. (RR 0.89; 95 % CI 0.70–1.14; p = 0.36; I2=0 %) The mean hospital length of stay (LOS) was significantly shorter in the patients who underwent MRgLITT. (MD -2.84 days; 95 % CI [-3.17]-[-2.51] days; p < 0.00001; I2=90 %) The mean operation duration was significantly longer in the intervention group. (MD 1.38 h; 95 % CI 0.64- 2.12 h; p = 0.00002; I2=55 %). The mean blood loss was significantly lower in patients who underwent MRgLITT. (MD -75.15 ml; 95 % CI [-92.82]-[-57.48] ml; p < 0.00001; I2=0 %) CC is a valuable option for treating RE, especially in children. The open surgery bears the stigma of an invasive and complicated technique which might justify its underuse. MRgLITT is a great alternative and possibly a way to widen the use of callosotomy in children, however, its cost and availability may be a challenge. [Display omitted]