Management of hypothalamic hamartomas: progress due to alignment of the stars

Rekate, Harold L.

doi:10.3171/2011.2.focus.intro

Cited by 8 publications

(8 citation statements)

References 19 publications

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“…13 However, risks of injury to limbic structures and central endocrine function, in addition to extended hospitalization for craniotomy, have inspired innovations in surgical technique aiming to achieve cure while reducing neurologic morbidity of open surgery. 14,15 Representing one such advancement, the transventricular neuroendoscopic approach for HH that lies within the third ventricle, is an effective alternative to open craniotomy with a transcallosal approach, with comparable efficacy and significantly shorter postoperative recovery time (mean 4.1 days vs. 7.7 days). [16][17][18][19][20][21] Stereotactic radiosurgery (SRS) is also an effective treatment option in patients with small HHs displaced from radiosensitive structures, which have a stable symptomatic picture affording them time (up to 18 months) for the effects of radiosurgery to occur.…”

Section: Discussionmentioning

confidence: 99%

“…In the hands of experienced surgeons, craniotomy with subtemporal, subfrontal, and transcallosal approaches have frequently resulted in excellent seizure control and marked improvement in behavioral and neuropsychiatric symptoms . However, risks of injury to limbic structures and central endocrine function, in addition to extended hospitalization for craniotomy, have inspired innovations in surgical technique aiming to achieve cure while reducing neurologic morbidity of open surgery . Representing one such advancement, the transventricular neuroendoscopic approach for HH that lies within the third ventricle, is an effective alternative to open craniotomy with a transcallosal approach, with comparable efficacy and significantly shorter postoperative recovery time (mean 4.1 days vs. 7.7 days) .…”

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confidence: 99%

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Laser interstitial thermal therapy: A first line treatment for seizures due to hypothalamic hamartoma?

Gandhi

Rekate

et al. 2017

Epilepsia

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Successful treatment of hypothalamic hamartoma (HH) can result in the resolution of its sequelae including epilepsy and rage attacks. Risks and morbidity of open surgical management of this lesion have motivated the development of laser interstitial thermal therapy (LITT) as a less invasive treatment approach to the disease. Although overall morbidity and risk would appear to be lower, complications related to LITT therapy have been reported, and the longer-term follow-up that is now possible after initial experience helps address the question of whether LITT provides equivalent efficacy compared to other treatment options. We conducted a retrospective analysis of clinical outcomes in eight patients undergoing LITT for HH at our center using the Visualase/Medtronic device. Five patients had refractory epilepsy, one had rage attacks, and two had both. We also compared the published seizure-free outcomes over time and the complication rates for different interventional approaches to the treatment of epilepsy due to HH including open craniotomy, neuroendoscopic, radiosurgical, and radiofrequency approaches. With a mean follow-up of 19.1 months in our series of eight patients, six of seven epilepsy patients achieved seizure freedom, whereas the one patient with rage attacks only did not have improvement of his symptoms. A length of hospital stay of 2.6 days reflects low morbidity and rapid postoperative recuperation with LITT. Considering other reported series and case reports, the overall published seizure freedom rate of 21 of 25 patients is superior to published outcomes of HH cases treated by stereotactic radiosurgery (SRS), craniotomy, or neuroendoscopy, and comparable to radiofrequency ablation. The cumulative experience of our center with other published series supports relatively lower operative morbidity than more invasive approaches and efficacy that is as good or better than open craniotomy procedures and SRS. Although morbidity appears to be lower than other open approaches, complications related to LITT and their avoidance should be considered carefully.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Laser interstitial thermal therapy: A first line treatment for seizures due to hypothalamic hamartoma?

Gandhi

Rekate

et al. 2017

Epilepsia

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“…An overview with the most common surgical routes and their feasibility is given in Table 4. One significant component was the development of the transcallosal approach and its variances to get very good access to the hypothalamus and treat almost every extent of the lesion [11,28,29]. The latest development of microsurgical techniques to treat HH was the use of neuroendoscopy, which has become increasingly popular [30].…”

Section: Discussionmentioning

confidence: 99%

Intraoperative use of high-field MRI in hypothalamic hamartomas associated with epilepsy: clinico-pathological presentation of five adult patients

Sommer¹,

Schlaffer²,

Coras³

et al. 2014

Acta Neurochir

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“…In earlier studies, the seizure outcomes were found to be variable with considerable complications7,20,26,31). However, surgical resection for total removal of HHs have led to good seizure outcomes and behavioral improvement10,30).…”

Section: Introductionmentioning

confidence: 99%

“…Recently stereotactic laser ablation has been introduced and good seizure control has been achieved. Modern imaging techniques and subsequent state of the art technology in surgical image guidance systems are critical to performing this delicate job 26) . Since the hypothalamic area is critical itself, even though we must achieve a good seizure outcome, we should avoid critical complications.…”

Section: Introductionmentioning

confidence: 99%

Endoscopic Treatment of Hypothalamic Hamartomas

Shim

Park

Kim

2017

J Korean Neurosurg Soc

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Hypothalamic hamartoma (HH) is a benign indolent lesion despite the presentation of refractory epilepsy. Behavioral disturbances and endocrine problems are additional critical symptoms that arise along with HHs. Due to its nature of generating epileptiform discharge and spreading to cortical region, various management strategies have been proposed and combined. Surgical approaches with open craniotomy or endoscopy, stereotactic approaches with radiosurgery and gamma knife surgery or radiofrequency thermos-coagulation, and laser ablation have been introduced. Topographical dimension and the surgeon’s preference are key factors for treatment modalities. Endoscopic disconnection has been one of the most favorable options performed in treating HHs. Here we discuss presurgical evaluation, patient selection, surgical procedures, and complications.

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Management of hypothalamic hamartomas: progress due to alignment of the stars

Cited by 8 publications

References 19 publications

Laser interstitial thermal therapy: A first line treatment for seizures due to hypothalamic hamartoma?

Laser interstitial thermal therapy: A first line treatment for seizures due to hypothalamic hamartoma?

Intraoperative use of high-field MRI in hypothalamic hamartomas associated with epilepsy: clinico-pathological presentation of five adult patients

Endoscopic Treatment of Hypothalamic Hamartomas

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