We introduced stereotactic radiosurgery (SRS) for mesial temporal lobe epilepsy (MTLE) in 1993. A series of clinical trials have demonstrated the efficacy and safety of this alternative to anterior temporal lobectomy and amygdalohippocampectomy. The disadvantage of Gamma Knife surgery (GKS) in MTLE is its delayed efficacy (usually around 1–2 years) which exposes the patient to the risk of SUDEP. The advantage of radiosurgery is its very low invasiveness and its proven capacity to spare verbal memory if that is at risk in case of resection. Young patients with MTLE of the dominant hemisphere with no major hippocampal atrophy nor verbal memory deficit, who are socially and professionally well integrated, are good indications. Patients who refuse open surgery are also considered candidates for radiosurgery. Laser interstitial thermal therapy (LITT) is an alternative of intermediate invasivity level. Preliminary results of LITT indicate a low risk of verbal memory loss and an instant effect. LITT carries a significant risk of hemorrhagic complications in the trajectory of the probe.