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71. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
9. Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

21.06. - 24.06.2020

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Stereotactic radiofrequency thermocoagulation for disconnection of epileptogenic hypothalamic hamartomas

Stereotaktische Radiofrequenzablation zur Diskonnektion epileptogener hypothalamischer Hamartome

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  • presenting/speaker Peter C. Reinacher - Universitätsklinikum Freiburg, Stereotaktische und Funktionelle Neurochirurgie, Freiburg, Deutschland; Fraunhofer-Institut für Lasertechnik ILT, Klinische Diagnostik und mikrochirurgische Systeme, Aachen, Deutschland
  • Volker Coenen - Universitätsklinikum Freiburg, Stereotaktische und Funktionelle Neurochirurgie, Freiburg, Deutschland
  • Mukesch Johannes Shah - Universitätsklinikum Freiburg, Klinik für Neurochirurgie, Freiburg, Deutschland
  • C. Steiert - Universitätsklinikum Freiburg, Klinik für Neurochirurgie, Freiburg, Deutschland
  • D. M. Altenmüller - Universitätsklinikum Freiburg, Epilepsiezentrum, Abteilung Prächirurgische Epilepsiediagnostik, Freiburg, Deutschland
  • Roland Roelz - Universitätsklinikum Freiburg, Klinik für Neurochirurgie, Freiburg, Deutschland
  • A. Schulze-Bonhage - Universitätsklinikum Freiburg, Epilepsiezentrum, Abteilung Prächirurgische Epilepsiediagnostik, Freiburg, Deutschland
  • J. Jacobs-Le Van - Universitätsklinikum Freiburg, Epilepsiezentrum, Abteilung Prächirurgische Epilepsiediagnostik, Freiburg, Deutschland; Universitätsklinikum Freiburg, Klinik für Neuropädiatrie und Muskelerkrankungen, Freiburg, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 71. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 9. Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie. sine loco [digital], 21.-24.06.2020. Düsseldorf: German Medical Science GMS Publishing House; 2020. DocV064

doi: 10.3205/20dgnc069, urn:nbn:de:0183-20dgnc0693

Published: June 26, 2020

© 2020 Reinacher et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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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 11/2019 we treated 19 consecutive patients (6 female, 13 male, age 1-55 years, median 7 years) with epileptogenic hypothalamic hamartomas (13 Delalande II, 3 Delalande III, 3 Delalande IV) with SRT. All patients underwent (at least 72h) video-EEG prior to treatment. A neuropsychologist evaluated pre- and postoperative intellectual and behavioral condition. 8 patients had previously undergone other treatments with no lasting improvement (3 open surgery, 5 stereotactic brachytherapy). 16 Patients had gelastic seizures (GS), 18 patients had non-gelastic seizures (nGS).

We carried out 1 procedure in 14, 2 procedures in 4 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 (0-38 months, median 12 months) freedom from GS was achieved in 94% (15/16) and freedom from nGS in 83% (15/18). All patients but two showed recovery or considerable improvement of their epilepsy (Engel Class 1: 74%, Engel Class 2: 11%, Engel Class 3: 5%, Engel Class 4: 11%).

1 patient had a bleeding in the hamartoma with a mild isolated deficit in verbal long-term memory (but heremained free of seizures), one patient had a weight gain of 10 kg, one patient a horner-syndrome and three a transient emotional facial paresis. Postoperative neuropsychological performance was unchanged or improved in 17/19 patients.

Conclusion: This minimally invasive approach appears to be a safe and effective alternative to surgery or radiation in patients with hypothalamic hamartomas.

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