Laser interstitial thermal therapy (LITT) is increasingly used as a surgical option for the treatment of epilepsy. Placement of the laser fibers relies on stereotactic navigation with cranial fixation pins. In addition, the laser fiber is stabilized in the cranium during the ablation using a cranial bolt that assumes maturity of the skull. Therefore, younger infants (< 2 years of age) have traditionally not been considered as candidates for LITT. However, LITT is an appealing option for patients with familial epilepsy syndromes, such as tuberous sclerosis complex (TSC), due to the multiplicity of lesions and the likely need for multiple procedures. A 4-month-old infant with TSC presented with refractory focal seizures despite receiving escalating doses of 5 antiepileptic medications. Electrographic and clinical seizures occurred numerous times daily. Noninvasive evaluations, including MRI, magnetoencephalography, scalp EEG, and SPECT, localized the ictal onset to a left frontal cortical tuber in the premotor area. In this paper, the authors report a novel technique to overcome the challenges of performing LITT in an infant with an immature skull by repurposing the Navigus biopsy skull mount for stereotactic placement of a laser fiber using electromagnetic-based navigation. The patient underwent successful ablation of the tuber and remained seizure free 4 months postoperatively. To the authors’ knowledge, this is the youngest reported patient to undergo LITT. A safe method is described to perform LITT in an infant using commonly available tools without dedicated instrumentation beyond standard stereotactic navigation, a biopsy platform, and the Visualase system.

激光间质热疗法（LITT）越来越多地用作治疗癫痫的手术选择。激光纤维的放置依赖于带有颅骨固定销的立体定向导航。此外，在消融过程中，使用假设颅骨成熟的颅骨螺栓将激光纤维稳定在颅骨中。因此，较小的婴儿（< 2 岁）历来不被视为 LITT 的候选者。然而，由于病变的多样性以及可能需要多次手术，LITT 对于患有家族性癫痫综合征（例如结节性硬化症 (TSC)）的患者来说是一个有吸引力的选择。一名 4 个月大的 TSC 婴儿尽管接受了 5 种抗癫痫药物剂量的递增治疗，但仍出现难治性局灶性癫痫发作。电图和临床癫痫发作每天发生多次。非侵入性评估，包括 MRI、脑磁图、头皮脑电图和 SPECT，将发作定位于运动前区域的左额叶皮质结节。在本文中，作者报告了一种新技术，通过重新利用 Navigus 活检颅骨支架，使用基于电磁的导航来立体定位激光纤维，从而克服对颅骨未成熟的婴儿进行 LITT 的挑战。患者成功进行了结节消融术，术后 4 个月保持无癫痫发作。据作者所知，这是接受 LITT 的最年轻的报告患者。描述了一种安全的方法，使用常用工具对婴儿进行 LITT，无需标准立体定向导航、活检平台和 Visualase 系统之外的专用仪器。