Compared to surgery, LITT provides minimal disruption of the brain matter, less post-operative pain and shorter length of stay. LITT has enabled a more minimalist approach to deep-seated targets such as the insula. Increasing utilization of stereoelectroencephalography has allowed for better identification of seizure onset involving the insular cortex and subsequent ablation, including many patients with prior surgeries involving the frontal, parietal, and temporal lobes. The insula serves as an ideal target for LITT, given the deep location and surrounding anatomic structures. There are limited studies on the efficacy of LITT in adults with lesional or non-lesional insular epilepsy. Retrospective LITT studies as well as comparisons with open surgical resection in the pediatric population have, however, shown good comparative efficacy while also demonstrating minimal, often transient, post-operative complications.