Article
Hypothalamic hamartoma – seizure outcome after disconnection with stereotactic radiofrequency thermocoagulation
Hypothalamisches Hamartom – Ergebnisse nach Diskonnektion mittels stereotaktischer Radiofrequenzablation
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Published: | June 4, 2021 |
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Objective: To evaluate safety and efficacy of disconnection of epileptogenic hypothalamic hamartomas with stereotactic radiofrequency thermocoagulation (SRT).
Methods: Between 07/2015 and 11/2020 we treated 30 consecutive patients (9 female, 21 male) with epileptogenic hypothalamic hamartomas with 38 SRT procedures. Patients with a follow up > 12 months after last intervention (n=18, 12 Delalande II, 3 Delalande III, 3 Delalande IV) were analyzed regarding seizure outcome and adverse events. All patients (6 female, 12 male, age 2-55, median 10, 11 children, 7 adults) underwent (at least 72h) video-EEG prior to treatment. A neuropsychologist evaluated pre- and postoperative intellectual and behavioral condition. 7 patients had previously undergone other treatments with no lasting improvement (2 open surgery, 5 stereotactic brachytherapy). Seizure types were: gelasitc (14), focal aware (6), focal non-aware (12), focal to bilateral tonic clonic (5) with a median epilepsy duration of 8.8 years (1-48). We carried out 1 procedure in 11, 2 procedures in 5 and 3 procedures in 1 case. Between 1 to 5 trajectories (median 3) with a total of 1 to 17 (median 6) coagulation targets were used per procedure (75°C, 60 seconds per target). Intraoperative stereotactic fluoroscopy was used to confirm the electrode position for each trajectory.
Results: At follow-up (12-50 months, median 23 months) seizure outcomes were: Engel Class 1: 77.7%, Engel Class 2: 5.6%, Engel Class 3: 11.1%, Engel Class 4: 5.6%). Freedom from gelastic seizures was achieved in 64.3% and freedom from non-gelastic seizures in 64.7% of affected patients. Emotional facial paresis occurred in 6 patients (24%, 3 transient, 3 permanent) and Horner syndrome in 1 patient (4%). 3 patients had a transient new neurological deficit (2 motor deficits, 1 vertical gaze palsy), all of them resolved completely until first follow-up. Postoperative neuropsychological performance was unchanged or improved in 16/18 patients.
Conclusion: This minimally invasive approach appears to be a safe and effective alternative to surgery or radiation in patients with hypothalamic hamartomas.