No abstract

OBJECTIVE Real-time, MRI-guided laser interstitial thermal therapy (MRgLITT) has been reported as a safe and effective technique for the treatment of epileptogenic foci in children and adults. After the recent approval of MRgLITT by the European Medicines Agency in April 2018, the authors began to use it for the treatment of hypothalamic hamartomas (HHs) in pediatric patients with the assistance of a robotic arm. In this study, the authors report their initial experience describing the surgical technique, accuracy of the robotic arm, safety, and efficacy. METHODS The laser fiber was placed with the assistance of the stereotactic robotic arm. The accuracy of the robotic arm for this procedure was calculated by comparing the intraoperative MRI to the preoperative plan. Common demographic and seizure characteristics of the patients, laser ablation details, complications, and short-term seizure outcomes were prospectively collected. RESULTS Sixteen procedures (11 first ablations and 5 reablations) were performed in 11 patients between 15 months and 17 years of age (mean age 6.4 years) with drug-resistant epilepsy related to HHs. The mean target point localization error was 1.69 mm. No laser fiber needed to be repositioned. The mean laser power used per procedure was 4.29 W. The trajectory of the laser fiber was accidentally ablated in 2 patients, provoking transient hemiparesis in one of these patients. One patient experienced postoperative somnolence and syndrome of inappropriate antidiuretic hormone secretion, and 2 patients had transient oculomotor (cranial nerve III) palsy. Fifty-four percent of the patients were seizure free after the first ablation (mean follow-up 22 months, range 15–33 months). All 5 patients who experienced an epilepsy relapse underwent a second treatment, and 4 remain seizure free at least 5 months after reablation. CONCLUSIONS In the authors’ experience, the robotic arm was sufficiently accurate for laser fiber insertion, even in very young patients. MRgLITT appears to be an effective treatment for selected cases of HH. MRgLITT for HH is a minimally invasive procedure with appealing safety features, as it allows delivery of energy precisely under real-time MRI control. Nonetheless, complications may occur, especially in voluminous HHs. The amount of delivered energy and the catheter cooling system must be closely monitored during the procedure. A larger sample size and longer follow-up duration are needed to judge the efficacy and safety of MRgLITT for HH more rigorously. This initial experience was very promising.

No abstract

No abstract

No abstract

No abstract

No abstract

ResumenLa Meningioangiomatosis (MA) es una lesión benigna intracraneal poco frecuente. La mayoría de los casos son aislados, pero también se han descrito casos asociados a Neurofibromatosis (NF) tipo 2. Los casos asociados a NF suelen ser asintomáticos. Los casos no asociados a NF son sintomáticos, se presentan en niños y adultos jóvenes, y en general afectan a leptomeninge y a corteza cerebral subyacente.En este trabajo se describen 2 casos no asociados a NF en niños de 1 y 7 años de edad, que se manifestaron por crisis, las cuales desaparecieron tras la extirpación de la lesión. Histológicamente las lesiones eran de predominio celular en un caso y de predominio fibro-hialino en el otro.De la revisión de la literatura se concluye que las meningioangiomatosis no asociadas a NF suelen ser lesiones únicas, clínicamente suelen presentarse con crisis convulsivas, y pueden verse asociadas a otras patologías, fundamentalmente a meningiomas.Histológicamente las lesiones corresponden a una proliferación celular de hábito meningotelial que se dispone alrededor de los vasos corticales. A pesar de que todos los casos tienen características comunes, existe un amplio espectro de formas histológicas, que abarca desde casos más celulares hasta casos más fibrosos con calcificaciones. Estas diferencias podrían corresponder a diferentes estadios evolutivos de la lesión. La extirpación de la lesión conlleva la desaparición de los sínto-mas.PALABRAS CLAVE: Corteza cerebral. Hamartoma, Leptomeninge. Meningioangiomatosis. Meningioma. Tumor. Meningioangiomatosis: report of two cases and literature review SummaryMeningioangiomatosis (MA) is a rare benign intracraneal lesion. The majority of cases are sporadic although the association of this lesion with familial neurofibromatosis (NF) type 2 is well known. NF-associated MA may be multifocal and is often asymptomatic and diagnosed at autopsy. Non-associated cases are usually symptomatic, occurs in children and young adults and frequently arise in leptomeninges and underlying cerebral cortex.In the present work, we describe two new non-associated cases of MA in two boys, seven and one year old with seizures that disappeared after surgical excision.Histopathologically, the lesion was predominantly cellular in one case and more fibrous in the other.From the literature review we concluded that sporadic cases present as single lesions which manifest by seizures or persistent headaches. Rarely MA has been described to coexist with meningiomas.Histopathologically IntroducciónLa meningioangiomatosis (MA) es una lesión intracraneal benigna poco frecuente, que suele presentarse en niños