Neurological complications after gamma-knife radiosurgery for hypothalamic hamartoma

Laiseca, Laura Butragueño; Oikonomopoulou, Niki; Herrero, M.C. Miranda; Valderrama, Estíbaliz Barredo; Vázquez-López, M; Domingo, Ana Jiménez de; Hoyo, Alejandra Aguado del; García-Leal, Roberto; Meiriño, R.

doi:10.1016/j.ejpn.2016.05.008

Cited by 9 publications

(4 citation statements)

References 7 publications

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“…Published series of HH treated with SRS demonstrate a 46.2% (24/52) seizure‐freedom rate with no permanent neurologic deficits. Laiseca notes a case of radiation‐related edema several months after the SRS treatment that required hospitalization for depressed consciousness, but which resolved completely . Large published series of surgical approaches to HH at high‐volume centers reported by Rosenfeld, Rekate, and Andrew achieved 48.6% (52/107) seizure‐freedom rates, with a 9–15% rate of permanent complications including memory loss and hemiparesis, endocrine dysfunction, and perioperative death …”

Section: Resultsmentioning

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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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: Resultsmentioning

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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“…Albumin has an immunomodulatory function, and hypoalbuminemia mice had abnormal macrophage activation and granuloma development. [32,33] A negative acute-phase protein during an inflammatory response to bacterial infection is serum albumin.…”

Section: Discussionmentioning

confidence: 99%

Hypoalbuminemia and colorectal cancer patients: Any correlation?: A systematic review and meta-analysis

et al. 2023

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Background: In malnourished patients with colorectal cancer, hypoalbuminemia is common and was proposed to determine the postoperative outcome of colorectal surgery. Mounting articles published but have not been evaluated. We aim to assess the predictive value of preoperative hypoalbuminemia in patients undergoing colorectal surgery.Methods: We performed a literature search from PubMed, Euro PMC, and Cochrane with the terms serum albumin, hypoalbuminemia, prognosis, outcome, colorectal cancer, and neoplasm. We also hand-searched and included any relevant papers. Hypoalbuminemia is defined as plasma albumin level < 3.5 mg/dL. We restricted the included studies to English language and adults undergoing colectomy, laparotomy, laparoscopy, or abdominoperineal resection. Any types of articles were included, except an abstract-only publication and those that did not report the key exposure or outcome of interest. The key exposures were mortality, hospitalization time, and morbid conditions (thrombosis, surgical site infection, sepsis, and wound events). We pooled the odds ratio from each included literature as effect size. The Newcastle Ottawa scale and GRADE were used to determine the quality of each included study.Results: Hereof 7 observational studies (236,480 individuals) were included. Our meta-analysis found that preoperative hypoalbuminemia can predict the postoperative outcome in colorectal cancer patients. Individuals with hypoalbuminemia were not associated with 30-day mortality (risk ratio [RR] 2.05 [0.72, 5.86], P = .18, I 2 = 99%) but were associated with morbidity (RR 2.28 [1.78,2.93], P < .00001, I 2 = 87.5%), surgical complication (RR 1.69 [1.34,2.13], P < .00001, I 2 = 98%), and hospitalization (RR 2.21 [1.93,2.52], P < .00001, I 2 = 0%). According to newcastle ottawa scale, the included studies are of moderate to sound quality. Conclusions:The current systematic review and meta-analysis showed that preoperative hypoalbuminemia was significantly associated with morbidity, length of stay, and surgical complication but not mortality.Abbreviations: BSA = basal serum albumin, CRC = colorectal cancer, NOS = newcastle ottawa scale, RR = risk ratio.

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“…Our group, as well as many others, have used radiosurgery to control gelastic seizures associated with HH. [15][16][17][18][19][20] We offered our second patient the option of Gamma Knife radiosurgery. One potential advantage of transcranial FUS over radiosurgery is the immediacy of the clinical effect.…”

Section: Discussionmentioning

confidence: 99%

Initial experience with magnetic resonance–guided focused ultrasound stereotactic surgery for central brain lesions in young adults

Tierney

Alavian

Altman³

et al. 2022

Journal of Neurosurgery

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OBJECTIVE Magnetic resonance–guided focused ultrasound (MRgFUS) is an incisionless procedure capable of thermoablation through the focus of multiple acoustic beams. Although MRgFUS is currently approved for the treatment of tremor in adults, its safety and feasibility profile for intracranial lesions in the pediatric and young adult population remains unknown. METHODS The long-term outcomes of a prospective single-center, single-arm trial of MRgFUS at Nicklaus Children’s Hospital in Miami, Florida, are presented. Patients 15–22 years of age with centrally located lesions were recruited, clinically consistent with WHO grade I tumors that require surgical intervention. This cohort consisted of 4 patients with hypothalamic hamartoma (HH), and 1 patient with tuberous sclerosis complex harboring a subependymal giant cell astrocytoma (SEGA). RESULTS In each case, high-intensity FUS was used to target the intracranial lesion. Real-time MRI was used to monitor the thermoablations. Primary outcomes of interest were tolerability, feasibility, and safety of FUS. The radiographic ablation volume on intra- and postoperative MRI was also assessed. All 5 patients tolerated the procedure without any complications. Successful thermoablation was achieved in 4 of the 5 cases; the calcified SEGA was undertreated due to intratumor calcification, which prevented attainment of the target ablation temperature. The HHs underwent target tissue thermoablations that led to MR signal changes at the treatment site. For the patients harboring HHs, FUS thermoablations occurred without procedure-related complications and led to improvement in seizure control or hypothalamic hyperphagia. All 5 patients were discharged home on postoperative day 1 or 2, without any readmissions. There were no cases of hemorrhage, electrolyte derangement, endocrinopathy, or new neurological deficit in this cohort. CONCLUSIONS This experience demonstrates that FUS thermoablation of centrally located brain lesions in adolescents and young adults can be performed safely and that it provides therapeutic benefit for associated symptoms.

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Neurological complications after gamma-knife radiosurgery for hypothalamic hamartoma

Cited by 9 publications

References 7 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?

Hypoalbuminemia and colorectal cancer patients: Any correlation?: A systematic review and meta-analysis

Initial experience with magnetic resonance–guided focused ultrasound stereotactic surgery for central brain lesions in young adults

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