Abstract
BACKGROUND: Hypothalamic hamartoma (HH) is a nonneoplastic tumor associated with precocious puberty and gelastic seizures, characterized by uncontrolled, inappropriate laughter. Successful treatment can resolve symptoms, but medications are often ineffective, and surgical treatment is complicated by the deep brain location. Laser interstitial thermal therapy (LITT) has been shown to be a safe alternative, but it has been suggested that it may not be suitable for larger lesions due to the increased risk of postoperative perilesional edema. OBSERVATIONS: The authors report the case of a giant sessile HH successfully treated with LITT. An 8-year-old male with a history of precocious puberty and refractory gelastic seizures presented for treatment of a giant HH first diagnosed in 2018. The authors performed robot-assisted stereotactic placement of a laser electrode and magnetic resonance imaging-guided ablation of the HH. He had no complications and has had a 90% seizure reduction as of 7 months postoperatively. They identified 4 studies describing LITT for giant HHs in the literature with conflicting results. LESSONS: There have been limited reports of LITT for giant HHs. The authors demonstrate that this modality can be a safe, effective option for patients with large lesions. https://thejns.org/doi/10.3171/CASE24628.