James IV Lecture. Epilepsy surgery, hypothalamic hamartomas and the quest for a cure.

This presentation reviews the epidemiology of epilepsy, the evolution of epilepsy surgery, the selection of cases for surgery, the range and results of epilepsy surgery, and the future development of this burgeoning field. Hypothalamic hamartoma (HH) is a rare developmental lesion which causes intractable gelastic epilepsy which is refractory to medical therapy. Hypothalamic hamartoma presents a formidable surgical challenge. The application of a midline transcallosal interforniceal approach to resect the HH from within the third ventricle, in a series of 28 patients, is presented. This has produced excellent results with minimal morbidity. This surgery is placed within the context of epilepsy surgery in general.