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• 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] [ABSTRACT FROM AUTHOR]