In common with other stereotactic procedures, stereotactic laser 
thermocoagulation (SLT) promises gentle destruction of pathological tissue, 
which might become especially relevant for epilepsy surgery in the future. 
Compared to standard resection, no large craniotomy is necessary, cortical 
damage during access to deep-seated lesions can be avoided and interventions 
close to eloquent brain areas become possible. We describe the history and 
rationale of laser neurosurgery as well as the two available SLT systems 
(Visualase® and NeuroBlate®; CE marks pending). Both systems are coupled with 
magnetic resonance imaging (MRI) and MR thermometry, thereby increasing patient 
safety. We report the published clinical experiences with SLT in epilepsy 
surgery (altogether approximately 200 cases) with respect to complications, 
brain structural alterations, seizure outcome, neuropsychological findings and 
treatment costs. The rate of seizure-free patients seems to be slightly lower 
than for resection surgery. Due to the inadequate quality of studies, the 
neuropsychological superiority of SLT has not yet been unambiguously 
demonstrated.