Hypothalamic hamartomas (HH) are rare, benign lesions that often cause medically intractable gelastic seizures and are associated with other seizure types, behavioral disturbances, and endocrine dysfunction. Traditional surgical approaches for HH carry a high morbidity risk. Magnetic Resonance-guided Laser Interstitial Thermal Therapy (MRgLITT) has emerged as a new, minimally invasive, and efficient alternative to surgery, offering the advantages of thermal coagulation with stereotactic precision. The use of magnetic resonance guidance provides real-time feedback during the surgery, allowing to monitor thermal damage more precisely and avoid critical structures. 

A comprehensive search was done on PubMed and Google Scholar. Keywords used were "MRgLITT", "hypothalamic hamartomas", "gelastic seizures". After full text screening and inclusion and exclusion criteria application, a total of 5 observational and case studies were retrieved for analysis. 

Out of the 5 studies, MRgLITT has showed high safety and efficacy in the treatment of hypothalamic hamartomas, demonstrating high seizure freedom rates, significant seizure reduction, with a low incidence of complications. All 5 studies included 139 patients, with 106 reporting seizure freedom after treatment with MRgLITT. This therapy was also noted for its consistently low morbidity, with Yao et al. (2022) showing complications in only six patients in the long term.

MRgLITT is a safe and effective minimally invasive option for patients with HH. It demonstrated high seizure freedom rates and significant seizure reduction, with a low incidence of major complications and a short hospital stay. Limitations include, the learning curve to perform MRgLITT, the epileptogenic mechanism of HHs that is still not well understood, the lesion's morphology and size which play a huge role, the retrospective nature of the included studies.