Stereoelectroencephalography-guided radiofrequency thermocoagulation for hypothalamic hamartoma: Electroclinical patterns and the relationship with surgical prognosis

Liu, Chang; Zheng, Zhong; Shao, Xiaoqiu; Li, Chunde; Yang, Xiaoli; Zhang, Chao; Lin, Shanshan; Xie, Fei; Feng, Zhanchun; Hu, Wenhan; Zhang, Kai

doi:10.1016/j.yebeh.2021.107957

Cited by 9 publications

(4 citation statements)

References 31 publications

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“…1 Strategy A: Less than five electrodes were implanted only within the target of HH, mainly for SEEG-guided RFTC by the same recording electrodes. This strategy was applied to the HH cases with a typical history of GS, and the size of the lesion was deemed suitable for RFTC ( 17 ).…”

Section: Methodsmentioning

confidence: 99%

Anatomical features decide the atypical seizure manifestation of parahypothalamic hamartomas

Liu

Zhang

et al. 2022

Front. Neurol.

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BackgroundThe intrahypothalamic phenotype of hypothalamic hamartomas (HH) is associated with epilepsy, and the parahypothalamic phenotype usually leads to central precocious puberty but not neurological comorbidities or seizures. No study has confirmed the pathological role of parahypothalamic hamartomas in epileptogenesis, and the underlying mechanism is yet to be elucidated.ObjectiveWe aimed to investigate whether parahypothalamic hamartomas are intrinsically epileptogenic and elucidate the underlying pathway of epileptogenesis.MethodsWe reviewed 92 patients with HH-related epilepsy, categorized them by the classification system of Delalande and Fohlen, and further classified Type I (corresponding to parahypothalamic HH) into the following three groups based on the relationship between the lesion and mammillary bodies (MB): entirely invaded (Group 1), partially connected (Group 2), and not connected at all (Group 3). We examined different anatomical features with their relationship to clinical manifestations. Stereoelectroencephalography (SEEG) was implanted in both HH and extra-HH cortices in different groups to identify the epileptogenic zone. Corticocortical evoked potentials (CCEPs) were also used to determine the pathological correlation among different regions to determine the related epileptogenic network.ResultsA total of 13 patients presented with parahypothalamic HH and 10 (76.9%) presented with non-GS only, with late-onset age and normal cognitive development, which is different from classical clinical features. SEEG showed that HH is intrinsically epileptogenic in MB-involved parahypothalamic groups. No statistical difference was found in onset age (p = 0.213), and lesions horizontally oriented from the tuber cinereum without connection to MB were not involved in seizure genesis. CCEP indicated a pathological connection among HH, middle cingulate cortex, and insular cortex.ConclusionThe parahypothalamic HH can also cause epilepsy and is different from classic HH-related seizures, by non-GS only with the late-onset age and normal cognitive development. MB is proven to be related to non-GS by the mamillo-cingulate-cortex pathway.

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Section: Methodsmentioning

confidence: 99%

Anatomical features decide the atypical seizure manifestation of parahypothalamic hamartomas

Liu

Zhang

et al. 2022

Front. Neurol.

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“…A trend toward association with seizure outcome was also recorded for patients with type 2 HH, in line with other series, 2 due to the purely intraventricular location. Type 2 was the most frequently treated type of HH, as reported in other series using ES, LITT or RF‐THC 3,10,12 ; type I and type III were more frequently reported in microsurgical series 13,14 and this aspect might reflect a selection bias. Based on the surgical outcome of our report, ES or LITT can be proposed as a first stage treatment for HH‐related epilepsy also in non‐type II HH, without excluding microsurgery after one or more failure of the so‐called “minimally invasive techniques.” Moreover, RF‐TC could represent a valid alternative to expensive techniques, especially in low‐income countries 10 .…”

Section: Discussionmentioning

confidence: 65%

Surgical and radiosurgical treatment of hypothalamic hamartoma: The Italian experience between 2011 and 2021

Rizzi,

Consales,

Tramacere

et al. 2024

Epilepsia Open

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ObjectiveTo investigate the Italian experience on the surgical and radiosurgical treatment of drug‐resistant epilepsy due to hypothalamic hamartoma (HH) in the period 2011–2021 in six Italian epilepsy surgery centers, and to compare safety and efficacy profiles of the different techniques.MethodsWe collected pseudo‐anonymized patient's data with at least 12 months of follow‐up. Surgical outcome was defined according to Engel classification of seizure outcome. Univariate analysis was performed to assess the risk of post‐operative seizures, categorized in dichotomous variable as favorable and unfavorable; explanatory variables were considered. Mann–Whitney or Chi‐squared test were used to assess the presence of an association between variables (p < 0.05).ResultsFull presurgical and postoperative data about 42 patients from 6 epilepsy surgery centers were gathered. Engel class I was reached in the 65.8% and 66.6% of patients with gelastic and non‐gelastic seizures, respectively. Other than daily non‐gelastic seizures were associated with seizure freedom (p = 0.01), and the radiological type presented a trend toward significance (p = 0.12).SignificanceEndoscopic disconnection and laser interstitial thermal therapy are effective in the treatment of HH‐related epilepsy, with a tolerable safety profile. Both gelastic and non‐gelastic seizures can be treated, also in patients with a long history of seizures.Plain Language SummaryThis study collected data about 42 patients with HH‐related epilepsies. Endoscopic disconnection and laser therapy are both effective and safe in the treatment of hypothalamic hamartoma‐related epilepsies.

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“…Prior systematic reviews and meta-analyses [41] have illustrated the efficacy of SgRFTC in focal, anatomically-limited epilepsies. Particular etiologic examples include hypothalamic hamartomas [42][43][44][45][46], hippocampal sclerosis [39], focal cortical dysplasias [34,[47][48][49], and periventricular heterotopias [35,42,50]. While current reported treatment outcomes are quite good, reaching up to 60% Engel 1 status [41], novel methodologies and applications may not only improve seizure freedom rates but also widen the scope of treatment.…”

Section: Future Of Sgrftcmentioning

confidence: 99%

Stereoelectroencephalography-Guided Radiofrequency Thermocoagulation: Diagnostic and Therapeutic Implications

Castellano,

Singla,

Barot

et al. 2024

Brain Sciences

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Despite recent medical therapeutic advances, approximately one third of patients do not attain seizure freedom with medications. This drug-resistant epilepsy population suffers from heightened morbidity and mortality. In appropriate patients, resective epilepsy surgery is far superior to continued medical therapy. Despite this efficacy, there remain drawbacks to traditional epilepsy surgery, such as the morbidity of open neurosurgical procedures as well as neuropsychological adverse effects. SEEG-guided Radiofrequency Thermocoagulation (SgRFTC) is a minimally invasive, electrophysiology-guided intervention with both diagnostic and therapeutic implications for drug-resistant epilepsy that offers a convenient adjunct or alternative to ablative and resective approaches. We review the international experience with this procedure, including methodologies, diagnostic benefit, therapeutic benefit, and safety considerations. We propose a framework in which SgRFTC may be incorporated into intracranial EEG evaluations alongside passive recording. Lastly, we discuss the potential role of SgRFTC in both delineating and reorganizing epilepsy networks.

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Stereoelectroencephalography-guided radiofrequency thermocoagulation for hypothalamic hamartoma: Electroclinical patterns and the relationship with surgical prognosis

Cited by 9 publications

References 31 publications

Anatomical features decide the atypical seizure manifestation of parahypothalamic hamartomas

Anatomical features decide the atypical seizure manifestation of parahypothalamic hamartomas

Surgical and radiosurgical treatment of hypothalamic hamartoma: The Italian experience between 2011 and 2021

Stereoelectroencephalography-Guided Radiofrequency Thermocoagulation: Diagnostic and Therapeutic Implications

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