Radiosurgery for hypothalamic hamartomas

Abstract

<jats:p>✓ Radiosurgery plays an important role in the treatment of refractory seizures induced by hypothalamic hamartomas (HHs). These lesions, deeply located and surrounded by a delicate vascular and neuronal network, are often associated with catastrophic epilepsy leading to progressive cognitive and behavioral deterioration. Surgical approaches include microsurgical resection, endoscopic resection or disconnection, radiofrequency lesioning, and interstitial brachytherapy. Radiosurgery is an emerging treatment modality for HHs, which provides excellent seizure outcomes and no lasting complications to date.</jats:p>

Endoscopic disconnection of hypothalamic hamartomas: safety and feasibility of robot-assisted, thulium laser–based procedures

“…Nevertheless, resective surgery carries the risk of severe complications including memory deficits, endocrinological disturbances, electrolyte disorders, motor deficits, and oculomotor impairment. 13,[24][25][26] Furthermore, total HH removal could be attained in approximately 50% of the procedures, but postoperative seizure control largely depends on the extent of the resection. 1 Finally, the resection is often complicated by the macroscopic appearance of the hamartoma that does not easily allow the surgeon to discriminate the limits of the lesion from the hypothalamus, which is frequently distorted by the lesion.…”

“…1 Stereotactic radiosurgery has shown promising results. [22][23][24]26 In some series in which stereotactic radiosurgery was used, satisfactory outcomes were obtained with a low incidence of adverse effects. Nevertheless, long-term effects of the irradiation of the hypothalamic area surrounding the lesion still need to be assessed.…”

“…Nevertheless, long-term effects of the irradiation of the hypothalamic area surrounding the lesion still need to be assessed. Furthermore, stereotactic radiosurgery requires several months to be effective, 22,24,29 while early seizure control is often necessary to avoid secondary epileptic encephalopathy. Nonetheless, stereotactic radiosurgery may play an important role in adult patients, who are less susceptible to radio-induced complications.…”

Surgical Methods in Epilepsy Surgery

“…[22][23][24][25] a) Transkallozal anterior forniseal mikrocerrahi yaklaşım b) Lateral pterional lamina terminalis yoluyla frontal orta hat yaklaşımı ve Monro forameninden endoskopik cerrahi c) Radyofrekans ablasyonu d) "Gamma-knife" cerrahisi.…”

Advances in Epilepsy Surgery

“…There are a number of published series that do not give the same efficacy rates in terms of seizure outcome. [26][27][28] Interpretation of these is complicated by differences in protocol, including dose, isodose centres or 'shots', and volume, but the discordance in results should not be ignored.…”