Stereotaxy for Hypothalamic Hamartoma with Intractable Gelastic Seizures: Technical Case Report

Fukuda, Masafumi; Kameyama, Shigeki; Wachi, Manabu; Tanaka, Ryuichi

doi:10.1097/00006123-199906000-00115

Cited by 41 publications

(36 citation statements)

References 11 publications

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“…In conjunction with the evolution of the surgery for HH was the increasing application of stereotactic radiosurgery. 28 Further treatment options for HH are radiofrequency lesioning 15,19 and interstitial radiotherapy with 125 I, 32,34 but the sample sizes reported are smaller and these treatments are not freely available.…”

Section: The Development Of Surgery For Hhmentioning

confidence: 99%

The evolution of treatment for hypothalamic hamartoma: a personal odyssey

Rosenfeld¹

2011

FOC

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The prognosis for patients with hypothalamic hamartoma has improved dramatically over the last 20 years, for 3 main reasons. First, because of improved understanding of the anatomy and pathophysiology of these varied lesions. Second, due to advances in brain imaging and refinements in microsurgery, including the anterior transcallosal interforniceal approach, endoscopic, and skull-base approaches. And third, because of increasing experience with stereotactic radiosurgery, interstitial radiotherapy, and radiofrequency lesioning. Patients with hypothalamic hamartoma should be managed in comprehensive epilepsy centers where the treatments are individualized and concentrated in the hands of surgeons who can perform the full range of surgery, including approaches to the third ventricle. Total seizure-freedom rates of 52% to 66% have been achieved with surgery.

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Section: The Development Of Surgery For Hhmentioning

confidence: 99%

The evolution of treatment for hypothalamic hamartoma: a personal odyssey

Rosenfeld¹

2011

FOC

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“…9,13,24,35,37,44,45 Substantial seizure improvement following resection, disconnection, or ablation is further proof of the intrinsic epileptogenesis of HHs and the need for a direct approach to produce seizure relief. [2][3][4]8,9,[12][13][14][16][17][18]24,25,28,35,36,[44][45][46][47][48]51,52 The degree of seizure control is linked to the extent of the surgical intervention. Incomplete resection, disconnection, or ablation of the HH can be associated with incomplete seizure control, whereas freedom from seizures may be induced by a more aggressive approach.…”

Section: Pathophysiology: Intrinsic Epileptogenesis Of Hhsmentioning

confidence: 99%

“…8 Radiofrequency ablation has also been described. 17,18,25,36 Surgical morbidity is limited overall, especially considering the challenging neural and vascular anatomy surrounding the HH, but includes thalamocapsular infarcts with resulting hemiparesis or hemiplegia, oculomotor palsy, visual field deficits, short-term memory deterioration, hyperphagia, hypothyroidism, and diabetes insipidus. 14,35,44 Complete seizure freedom is difficult to achieve, but in most cases remarkable long-term improvements have been reported with near-total resolution of disabling seizure types and enhanced cognitive and psychosocial abilities.…”

Section: Pathophysiology: Intrinsic Epileptogenesis Of Hhsmentioning

confidence: 99%

Radiosurgery for hypothalamic hamartomas

Romanelli

Muacevic²,

Striano

2008

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✓ 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.

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“…4,17) The epilepsy is frequently refractory to antiepileptic drugs. Depth electrode recordings have demonstrated that gelastic seizures arise within the hamartoma, 1,3,5,7,11,13) so resection of the hamartoma seems to be the most appropriate treatment.…”

Section: Introductionmentioning

confidence: 99%

“…Recently, various therapeutic approaches for epilepsy have been attempted with encouraging results, including gamma knife surgery, 2,18,22) radiofrequency thermocoagulation, 7) and chronic electrical stimulation of the hamartoma and microsurgery using different routes. 14,15,20,23) Most previous studies have included single cases or series, some of precocious puberty only, others with epilepsy only or both.…”

Section: Introductionmentioning

confidence: 99%

Disconnecting Surgical Treatment of Hypothalamic Hamartoma in Children and Adults With Refractory Epilepsy and Proposal of a New Classification.

Delalande

Fohlen

2003

Neurol. Med. Chir.(Tokyo)

255

175

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Hypothalamic hamartoma associated with intractable epilepsy is a major problem when surgical management is discussed. Professor Olivier Delalande is Chief Neurosurgeon of the Department of Pediatric Neurosurgery, Fondation Ophtalmologique Adolf de Rothschild, in Paris, France. In recent international symposia, he has reported a series of hypothalamic hamartoma in children and adults with refractory epilepsy, managed with various surgical techniques according to his new classification of hypothalamic hamartomas. With the permission of Professor Akira Yamaura, Chief Editor of the Neurologia medico-chirurgica, this stimulating paper has appeared in this issue. The strategies of his surgery using surgical excision, surgical disconnection or endoscopic disconnection are challenging but safe. His surgical outcomes are that 8 patients are seizure free, one patient has only brief gelastic seizures and 8 patients are dramatically improved. I hope that the authors will have the opportunity to again examine the outcomes in their series several years from now.Tatsuya TANAKA, M.D., D.M.Sc., President of the 30th Annual Meeting of the Japan Society for Pediatric Neurosurgery. AbstractA series of 17 patients aged from 9 months to 32 years with refractory epilepsy due to hypothalamic hamartoma were treated by total removal (one case) and disconnection (16 cases) between 1997 and 2002. The mean age at seizure onset was 16 months. Sixteen patients had gelastic seizures, 14 had partial seizures and three had generalized tonic-clonic seizures. The mean seizure frequency was 21 per day. Four patients had borderline intelligence quotient and the others were mentally retarded. Five patients presented with precocious puberty, one with acromegaly, and four suffered from obesity. Brain magnetic resonance imaging, performed at least twice in each patient, showed the hamartoma as a stable homogeneous interpeduncular mass implanted either on the mammilary tubercle or on the wall of the third ventricle with variable extension to the bottom. Ictal single photon emission computed tomography, performed in four patients, showed hyperperfusion within the hamartoma in two patients. Twenty-five operations were performed in the 17 patients. The first patient underwent total removal of the hamartoma, whereas the following 16 patients underwent disconnection through open surgery (14 procedures) and/or endoscopy (9 procedures). Eight patients became seizure-free, one patient had only brief gelastic seizures, and eight patients were dramatically improved with a mean follow up of 18.6 months (8 days to 43 months). Surgery was safe in all but two patients: the first patient had transient hemiplegia and the third cranial nerve paresis, and the other developed hemiplegia due to ischemia of the middle cerebral artery territory. The quality of life, and behavior and school performance were greatly improved in most patients. Our series illustrates the feasibility and relative safety of disconnection surgery for hypothalamic hamartomas with seizure relief in 5...

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Stereotaxy for Hypothalamic Hamartoma with Intractable Gelastic Seizures: Technical Case Report

Cited by 41 publications

References 11 publications

The evolution of treatment for hypothalamic hamartoma: a personal odyssey

The evolution of treatment for hypothalamic hamartoma: a personal odyssey

Radiosurgery for hypothalamic hamartomas

Disconnecting Surgical Treatment of Hypothalamic Hamartoma in Children and Adults With Refractory Epilepsy and Proposal of a New Classification.

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