Hypothalamic hamartoma (HH) is a rare nonneoplastic gray matter heterotopia that is characteristically associated with drug-resistant epilepsy and/or precocious puberty. Surgical treatment provides the best chance of seizure control, yet traditional open microsurgical approaches may be associated with morbidity. In recent years, interest has increased in the use of laser interstitial thermal therapy for the treatment of HH due to its minimally invasive nature, ability to reduce approach-related morbidity, and real-time MRI monitoring. Treatment concepts, planning strategies, and results are presented.