Lesioning

Indication

Because it is a non discrete lesion and hard to differentiate from normal brain under microscope

Max diameter of lesion for one catheter 15mm but can increased by pulling back the catheter

Images

Outcomes

Laser interstitial thermal therapy (LITT) for hypothalamic hamartoma (HH) appears highly effective for seizure control with relatively low morbidity
Pooled LITT series: 21 of 25 patients (84%) were seizure free at similar follow‑up, with permanent complications in about 8% (epidural hematoma and one mammillary body injury with severe anterograde amnesia in a previously lobectomized patient).
Stereotactic radiofrequency thermocoagulation: large series report roughly 71% seizure freedom, with low but non‑zero pituitary morbidity.
Stereotactic radiosurgery: about 46% seizure freedom, with risks including delayed radiation‑related edema and a therapeutic latency of 12–18 months.
Open or endoscopic approaches: around 49% seizure freedom, with 9–15% permanent complications, including memory, motor, and endocrine deficits, and rare perioperative death.

Technique	Mechanism / energy	Access type	Typical indications / niche
Lesionectomy / focal resection	Mechanical excision	Open craniotomy	Discrete structural lesion with well-localized focus.
Stereotactic RF thermocoagulation	Radiofrequency heat	Depth electrodes / burr holes	Deep or multifocal foci, often with invasive EEG in place.
Laser interstitial thermal therapy	Laser-induced heat	Stereotactic, burr hole	Mesial temporal lobe, deep or hard-to-reach lesions.
Stereotactic radiosurgery	Focused ionizing radiation	Non invasive	Medial temporal, hypothalamic hamartoma, AVMs.
MR‑guided focused ultrasound (MRgFUS)	Focused ultrasound heat	Non invasive	Select deep targets in investigational protocols.