Neurosurgical Aspects of Hypothalamic Disease

Lesions within the hypothalamus pose many difficulties for a neurosurgeon – the intricate anatomy and numerous critical structures surrounding it make the hypothalamus a difficult region of the brain to access. When considering neurosurgical management of hypothalamic lesions, there are a number of possible approaches dependent on the type of lesion and the location within the thalamus. Numerous lesions and diseases can involve the hypothalamus, resulting in compromised function of numerous endocrine systems, sleep-wake cycle, vision, memory, and emotional regulation. When these lesions arise and surgical management is indicated, there are five well-reported approaches to these lesions – each with their benefits and associated risks/considerations for surgical approach. A solid foundational knowledge of the anatomy of the region surrounding the hypothalamus, characteristics of the lesion itself, and the specific location of the lesion in question guide the choice of surgical approach when assessing hypothalamic disease.