gms | German Medical Science

72. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

06.06. - 09.06.2021

Hypothalamic hamartoma – seizure outcome after disconnection with stereotactic radiofrequency thermocoagulation

Hypothalamisches Hamartom – Ergebnisse nach Diskonnektion mittels stereotaktischer Radiofrequenzablation

Meeting Abstract

  • presenting/speaker Peter C. Reinacher - Universitätsklinikum Freiburg, Abteilung Stereotaktische und Funktionelle Neurochirurgie, Freiburg, Deutschland
  • Mukesch Johannes Shah - Universitätsklinikum Freiburg, Neurochirurgische Klinik, Freiburg, Deutschland
  • Christine Steiert - Universitätsklinikum Freiburg, Neurochirurgische Klinik, Freiburg, Deutschland
  • Dirk Altenmüller - Universitätsklinikum Freiburg, Epilepsiezentrum, Freiburg, Deutschland
  • Alexandra Klotz - Universitätsklinikum Freiburg, Epilepsiezentrum, Freiburg, Deutschland; Universitätsklinikum Freiburg, Klinik für Neuropädiatrie und Muskelerkrankungen, Freiburg, Deutschland
  • Theo Demerath - Universitätsklinikum Freiburg, Neuroradiologische Klinik, Freiburg, Deutschland
  • Andreas Schulze-Bonhage - Universitätsklinikum Freiburg, Epilepsiezentrum, Freiburg, Deutschland
  • Volker A. Coenen - Universitätsklinikum Freiburg, Abteilung Stereotaktische und Funktionelle Neurochirurgie, Freiburg, Deutschland
  • Julia Jacobs-Le Van - Universitätsklinikum Freiburg, Epilepsiezentrum, Freiburg, Deutschland; Universitätsklinikum Freiburg, Klinik für Neuropädiatrie und Muskelerkrankungen, Freiburg, Deutschland; University of Calgary, Department of Paediatrics and Department of Neuroscience, Cumming School of Medicine, Calgary, Kanada

Deutsche Gesellschaft für Neurochirurgie. 72. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgie. sine loco [digital], 06.-09.06.2021. Düsseldorf: German Medical Science GMS Publishing House; 2021. DocV176

doi: 10.3205/21dgnc171, urn:nbn:de:0183-21dgnc1714

Veröffentlicht: 4. Juni 2021

© 2021 Reinacher et al.
Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung). Lizenz-Angaben siehe http://creativecommons.org/licenses/by/4.0/.


Gliederung

Text

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.

Figure 1 [Fig. 1], Figure 2 [Fig. 2]