153 Laser Interstitial Thermal Therapy Achieves Seizure and Medication Freedom in Pediatric Patients With Hypothalamic Hamartoma

INTRODUCTION: Hypothalamic hamartomas (HH) are benign lesions that may cause drug-resistant seizures. The surgical treatment of HH has transitioned towards less invasive approaches, including laser interstitial thermal therapy (LITT). However, studies describing the efficacy of LITT for treating HH in the pediatric population are scarce. METHODS: A single institution retrospective chart review of all patients under age 20 who underwent LITT for HH was performed. Patient demographics, lesion and treatment characteristics, and postoperative functional and seizure outcomes were collected. RESULTS: Seven patients who underwent LITT for HH (mean HH volume 2.5 ± 2.4 cc) were identified with a mean follow-up of 19 months (range 5-34 months). Preoperatively, six patients (86%) experienced daily gelastic seizures and one patient (14%) had daily hemiclonic motor seizures. Post-LITT, all seven patients exhibited seizure freedom (Engel I outcome) at last follow-up, and three patients had discontinued all antiepileptic medications. In one case, a second LITT treatment was performed after a three-week interval using an alternate laser trajectory due to insufficient ablation during the first procedure. Additionally, there was one case of transient radiographic, but asymptomatic, hydrocephalus that resolved within three months, and another case of postoperative hemiparesis that fully resolved by 9-month follow-up. There were no treatment-related mortalities or postoperative hemorrhages. CONCLUSIONS: This retrospective case series demonstrates that LITT can safely and effectively decrease seizure burden in pediatric patients with HH. Further examination of the relative benefits of LITT compared to other surgical interventions for HH remains warranted.