A rare focal malformation that resembles a neoplasm. The most common central nervous system hamartoma occurs inferior to the hypothalamus, either parahypothalamically or intrahypothalamically. Initial symptoms include precocious puberty, gelastic (laughing) seizures, and vision problems. Although hamartomas rarely invade or compress the surrounding structures significantly, secondary behavioral and cognitive problems may develop in childhood, leading to significant disability. Consequently, resection and radiosurgery are often the utilized treatment options.