The desire to achieve seizure freedom with low risk of cognitive impairment and other surgical morbidity has led to the introduction of minimally invasive techniques including laser interstitial thermal therapy (LITT). In recent years, LITT has gained popularity in the treatment of mesial temporal lobe epilepsy, owing to the ability to percutaneously ablate the mesial temporal structures while sparing the temporal neocortex. A growing body of literature suggests that compared to resection, LITT is associated with a lower risk of neuropsychological decline and visual field deficit, at the expense of a moderate decrease in the likelihood of seizure freedom.