Minimally Invasive Magnetic Resonance Imaging-Guided Stereotactic Radiofrequency Thermocoagulation for Epileptogenic Hypothalamic Hamartomas

Kameyama, Shigeki; Murakami, Hiroatsu; Masuda, Hiroshi; Sugiyama, Ichiro

doi:10.1227/01.neu.0000348292.39252.b5

Cited by 86 publications

(86 citation statements)

References 41 publications

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“…2,5,6,11,13,18,25,26,28,30 Our case confirms that the epilepsy syndrome observed in adults with HH is different from the catastrophic epilepsy that develops in childhood. When epilepsy begins later, learning and behavioral problems are fewer, gelastic seizures are less prominent, and the epilepsy syndrome is usually restricted to 1 or 2 partial seizure types.…”

Section: Discussionsupporting

confidence: 72%

Deep brain stimulation for the treatment of drug-refractory epilepsy in a patient with a hypothalamic hamartoma

Marras

Rizzi²,

Villani

et al. 2011

FOC

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Hypothalamic hamartomas (HHs) are developmental malformations associated with a range of neurological problems, including intractable seizures. There is increasing evidence of the epileptogenicity of the hamartoma and of the inhomogeneous distribution of the epileptic abnormalities within the malformation. The management strategy for treatment and results differ according to the insertion plane and the extension of the malformation into the hypothalamus. Cases characterized by extensive involvement of the hypothalamus are particularly challenging. The authors describe the case of a patient with drug-resistant epilepsy and a large hypothalamic hamartoma with an extensive area of attachment. The patient underwent implantation of 2 deep brain electrodes. The intraoperative recording showed a synchronous interictal epileptic discharge in the left temporal lobe and on the left side of the lesion. The patient was treated with chronic high-frequency stimulation. No side effects due to the stimulation were reported. At 18 months' follow-up, a reduction in complex partial seizure frequency was reported, but no significant reduction in overall seizure frequency was noticed (p = 0.14, t-test). The authors report on neurophysiological studies of the relationship between HH and epilepsy, and also discuss the literature on chronic high-frequency stimulation, including its rationale and the results of chronic stimulation of various targets for the treatment of drug-resistant epilepsy due to HH.

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Section: Discussionsupporting

confidence: 72%

Deep brain stimulation for the treatment of drug-refractory epilepsy in a patient with a hypothalamic hamartoma

Marras

Rizzi²,

Villani

et al. 2011

FOC

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“…10 Nonetheless, some hamartomas are not particularly amenable to these treatments or are refractory to them. Further, approach-related morbidity is significant in many of these approaches and may be abated by MRg-LITT.…”

Section: 20mentioning

confidence: 99%

Magnetic resonance imaging–guided laser interstitial thermal therapy for previously treated hypothalamic hamartomas

Burrows¹,

Marsh²,

Worrell

et al. 2016

FOC

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OBJECTIVE Hypothalamic hamartomas (HHs) are associated with gelastic seizures and the development of medically refractory epilepsy. Magnetic resonance imaging–guided laser interstitial thermal therapy (MRg-LITT) is a minimally invasive ablative treatment that may have applicability for these deep-seated lesions. Here, the authors describe 3 patients with refractory HHs who they treated with MRg-LITT. METHODS An institutional review board–approved prospective database of patients undergoing Visualase MRg-LITT was retrospectively reviewed. Demographic and historical medical data, including seizure and medication histories, previous surgeries, procedural details, and surgical complications, along with radiological interpretation of the HHs, were recorded. The primary outcome was seizure freedom, and secondary outcomes included medication reduction, seizure frequency, operative morbidity, and clinical outcome at the latest follow-up. RESULTS All 3 patients in the multi-institutional database had developed gelastic seizures related to HH at the ages of 7, 7, and 9 years. They presented for further treatment at 25, 28, and 48 years of age, after previous treatments with stereotactic radiosurgery in all cases and partial hamartoma resection in one case. One ablation was complicated by a small tract hemorrhage, which was stable on postoperative imaging. One patient developed hyponatremia and experienced weight gain, which were respectively managed with fluid restriction and counseling. At the most recent follow-up at a mean of 21 months (range 1–32 months), one patient was seizure free while another had meaningful seizure reduction. Medication was reduced in one case. CONCLUSIONS Adults with gelastic seizures despite previous treatments can undergo MRg-LITT with reasonable safety and efficacy. This novel therapy may provide a minimally invasive alternative for primary and recurrent HH as the technique is refined.

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“…Apart from frontal, pterional, subtemporal, and transcallosal approaches and transventricular endoscopy, novel techniques, such as synchronous endoscopy and microsurgery, Gamma Knife surgery, radiofrequency ther- mocoagulation, and interstitial radiosurgery, have been attempted with varying degrees of success. 5,25,39,49,54 The surgical management of HHs can be extremely cumbersome. Most neurosurgeons have adopted the transcallosal or transventricular endoscopic approach for HH resection.…”

Section: Treatment Of Hhmentioning

confidence: 99%

Hypothalamic hamartoma simulating a suprasellar arachnoid cyst: resolution of precocious puberty following microsurgical lesion resection

Manjila

Vogel

Chen

et al. 2014

PED

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Hypothalamic hamartomas (HHs) are rare developmental lesions arising from the inferior hypothalamus that may cause gelastic seizures and central precocious puberty. Cystic changes in HHs are rare, usually occurring in giant lesions. The authors describe an unusual case of cystic HH masquerading as a suprasellar arachnoid cyst in an 18-month-old girl presenting with precocious puberty. Microsurgical removal of the lesion led to complete resolution of the precocious puberty on long-term follow-up. This case is the first reported HH with pathological demonstration of corticotropin-releasing hormone immunostaining in the solid tumor and glial cells in the cyst wall of the lesion. The clinical and radiological characteristics of HHs are reviewed, along with the unique surgical strategies used to manage cystic lesions in the suprasellar region.

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Minimally Invasive Magnetic Resonance Imaging-Guided Stereotactic Radiofrequency Thermocoagulation for Epileptogenic Hypothalamic Hamartomas

Abstract: The present SRT procedure has favorable efficacy and invasiveness and has no adaptive limitations. SRT should therefore be considered before adulthood. The new HH classification is useful to understand clinical symptoms and to determine surgical strategies.

Cited by 86 publications

References 41 publications

Deep brain stimulation for the treatment of drug-refractory epilepsy in a patient with a hypothalamic hamartoma

Deep brain stimulation for the treatment of drug-refractory epilepsy in a patient with a hypothalamic hamartoma

Magnetic resonance imaging–guided laser interstitial thermal therapy for previously treated hypothalamic hamartomas

Hypothalamic hamartoma simulating a suprasellar arachnoid cyst: resolution of precocious puberty following microsurgical lesion resection

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