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

Abstract

<jats:sec> <jats:title>OBJECTIVE</jats:title> <jats:p>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.</jats:p></jats:sec> <jats:sec> <jats:title>METHODS</jats:title> <jats:p>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.</jats:p></jats:sec> <jats:sec> <jats:title>RESULTS</jats:title> <jats:p>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.</jats:p></jats:sec> <jats:sec> <jats:title>CONCLUSIONS</jats:title> <jats:p>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.</jats:p></jats:sec>

Hypothalamic hamartomas in adulthood: Clinical spectrum and treatment outcome—A unicenter experience

“…Régis et al published a prospective series of 57 patients with HH treated with GK with a 3‐year follow‐up in 48 of them and a range of age from 3 to 50 years. Good result (Engel class I or II) was achieved in 68.8% of the patients in terms of seizure control and none of the patients showed cognitive decline or disabling endocrinological deficits after treatment (Burrows et al, ). The latest surgical approach for HH associated with refractory epilepsy is the magnetic resonance imaging‐guided laser interstitial thermal therapy (MRg‐LITT), which offers the advantage of real‐time imaging of direct thermal ablation with minimal major surgical complications (Du, Gandhi, Rekate, & Mehta, ).…”

Emerging indications for stereotactic laser interstitial thermal therapy in pediatric neurosurgery

“…It is important to note that disconnection of the lesion from the epileptogenic network is important, and often sufficient to resolve seizures rather than complete ablation or resection of the lesion itself. Burrows et al reported three cases of patients with decades of refractory symptoms after initial presentation in childhood who had undergone resection or radiosurgery previously, of which one was seizure free and one had meaningful reduction in seizure frequency [36].…”

Achieving a cure for hypothalamic hamartomas: a Sisyphean quest?

“…In the early 2010s, new stereotactic thermocoagulation methods using magnetic resonance (MR) guidance such as highly focused ultrasound (HIFU) and laser interstitial (LITE) thermocoagulation were introduced to the field of functional neurosurgery and tested for the treatment of HH. No series of HIFU for HH has been published to date.…”

“…The fact that no destructive effect is observed in most of the patients after radiosurgery 36,37 may explain why no memory deficits have been found (even with long-term follow-up) after radiosurgery despite the use of a battery of standardized neuropsychological tests exploring intelligence and memory (immediate and delayed verbal and visual memory). 29 In the early 2010s, new stereotactic thermocoagulation methods using magnetic resonance (MR) guidance such as highly focused ultrasound (HIFU) and laser interstitial (LITE) 38 thermocoagulation were introduced to the field of functional neurosurgery and tested for the treatment of HH. No series of HIFU for HH has been published to date.…”