From competition to complementarity: narrative review of laser interstitial thermal therapy, focused ultrasound, and radiofrequency ablation in minimally invasive neurosurgery

Minimally invasive neurosurgical techniques have emerged as a transformative paradigm, offering alternatives to conventional open approaches. The demand for safer, less invasive procedures accelerated the development of laser interstitial thermal therapy (LITT), focused ultrasound (FUS), and radiofrequency ablation (RFA), each employing a distinct mechanism with unique clinical implications. The objective was to critically evaluate and contextualize LITT, FUS, and RFA with emphasis on their comparative efficacy, safety, and roles as competing or complementary technologies in minimally invasive neurosurgery. Literature published between 2005 and 2025 was identified through PubMed, Scopus, and Web of Science, using keywords “LITT,” “FUS,” “RFA,” “minimally invasive neurosurgery,” “epilepsy,” “glioma,” and “movement disorders.” Eligible English studies included clinical trials, systematic reviews, meta-analyses, and large observational studies. The extracted data were synthesized narratively, focusing on clinical indications, efficacy, safety, and patient-centered outcomes. Evidence highlights the roles of LITT, FUS, and RFA across tumors, epilepsy, and movement disorders with differing efficacy and safety indications. LITT is most effective in gliomas and metastases, FUS shows its strongest evidence in movement disorders, whereas LITT and RFA via stereo-electroencephalography-guided thermocoagulation remain relevant in epilepsy. Reported safety outcomes include edema with LITT, skull heating with FUS, and hemorrhage with RFA. Patient-centered outcomes across modalities suggest shorter recovery periods, improved cosmesis and quality of life, and favorable cost-effectiveness. LITT, FUS, and RFA represent complementary rather than competitive modalities in minimally invasive neurosurgery. Advances in imaging, navigation, thermal technologies, and patient-centered approaches are likely to accelerate their integration into cohesive, multimodal neurosurgical strategies.