How would we deal with hypothalamic hamartomas?

Table 1 Advantages and disadvantages between modalities

Treatment modality	Advantages	Disadvantages
Endoscopic surgery	Minimally invasive	Multiple approaches for large HHs
	Low possibility to injure adjacent critical structures	Dependent on surgeon's experience
	Critical tissue borders are readily apparent
	Relatively low complication even with Re-do surgery
	Relatively easy approach to the intrathird ventricular lesion
Open surgery with craniotomy
The standard pterional approach	The risk of endocrinological and hypothalamic damage may be lower than transcallosal approach	High complication rates
		Difficulties in completely excising the lesion which extended into third ventricle
		Inadequate exposure is usual
		Critical tissue borders are not readily apparent
Transcallosal interforniceal approach	Complete or nearly complete resection of HHs can be safely achieved via this approach	Surgical trauma to the septal, forniceal, or mammillary body
	Can be used alone to treat large HHs	The risk of endocrinological and hypothalamic damage may be higher
	Injuries to the optic tract and cranial nerve were rare
Radiosurgery	Does not require invasive surgery	Delayed (4-6 mo) response
	Provide a chance to achieve seizure freedom without hypothalamic or cranial nerve damage	Long-term seizure freedom are not clear
		Lesions smaller than 30 mm
		Dose-dependent response
Stereotactic radiofrequency ablation	Effective for a small hamartoma	Effective for a small hamartoma
	Immediate response	Inexact volume of tissue ablation
		Multiple trajectories to treat larger hamartomas
Neuromodulation	No behavioral, endocrinological, or neurological side effects has been reported	No definite change in overall seizure frequency

HHs: Hypothalamic hamartomas.