Surgical treatment of hypothalamic hamartomas

International audienceHypothalamic hamartomas are aberrant masses, composed of abnormally distributed neurons and glia. Along endocrine and cognitive symptoms, they may cause epileptic seizures, including the specific gelastic and dacrystic seizures. Surgery is the treatment of drug resistant hamartoma epilepsy, with associated positive results on endocrine, psychiatric and cognitive symptoms. Recently, alternatives to open microsurgical treatment have been proposed. We review these techniques and compare their efficacy and safety. Open resection or disconnection of the hamartoma, either through pterional, transcallosal or transventricular approach, leads to good epileptological control but its high complication rate, up to 30%, limits its indications. The purely cisternal peduncular forms remain the only indication of open, pterional, approach, while other strategies have been developed to overcome the neurological, endocrine, behavioral or cognitive complications