Laser interstitial thermal therapy (LITT) is being performed more frequently for various lesions within neurosurgery, including epileptic foci, vascular malformations, and tumors. Though this technique generally has an excellent safety profile, it is important to be aware of potential complications. Thermal ablation of tissue leads to disruption of the blood brain barrier as well as an inflammatory response both of which cause the majority of complications from LITT. The most common complications of LITT include cerebral edema, focal neurologic deficits, and intracranial hemorrhage. Few studies have identified factors predicting development of these complications, but many of these are transient and resolve without intervention. Modifications to LITT technique that allows better visualization of patient anatomy along the tract, such as fusing vascular imaging with intraoperative MRI, reduce the risk of complications.