Hypothalamic hamartomas are often associated to a progressive epileptic encephalopathy. Non-invasive data indicates that destruction or isolation of the hamartoma may stop seizures. We present data on patients who underwent stereotactic radiofrequency with or without endoscopy. Epilepsy improved in 60% of patients with minimal morbidity. This approach was less succesful in large lesions. These results indicate that this approach should be considered in patients with small/medium lesions.