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El-Shehaby AMN, Reda WA, Abdel Karim KM, Nabeel AM, Emad Eldin RM, Tawadros SR. Response to Letter: Radiosurgery for Colloid Cyst - Surgeon Patriarchy or Patient Autonomy? Stereotact Funct Neurosurg 2024:1-2. [PMID: 39326399 DOI: 10.1159/000541145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2024] [Accepted: 08/16/2024] [Indexed: 09/28/2024]
Affiliation(s)
- Amr M N El-Shehaby
- Gamma Knife Center Cairo, Nasser Institute For Research and Treatment, Cairo, Egypt
- Neurosurgery Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Wael A Reda
- Gamma Knife Center Cairo, Nasser Institute For Research and Treatment, Cairo, Egypt
- Neurosurgery Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Khaled M Abdel Karim
- Gamma Knife Center Cairo, Nasser Institute For Research and Treatment, Cairo, Egypt
- Clinical Oncology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Ahmed M Nabeel
- Gamma Knife Center Cairo, Nasser Institute For Research and Treatment, Cairo, Egypt
- Radiation Oncology Department, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Reem M Emad Eldin
- Gamma Knife Center Cairo, Nasser Institute For Research and Treatment, Cairo, Egypt
- Neurosurgery Department, Faculty of Medicine, Benha University, Banha, Egypt
| | - Sameh R Tawadros
- Gamma Knife Center Cairo, Nasser Institute For Research and Treatment, Cairo, Egypt
- Neurosurgery Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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Kundishora AJ, Reeves BC, Lerner DK, Storm PB, Prelack MS, Palmer JN, Adappa ND, Kennedy BC. Endoscopic endonasal resection of olfactory tract hamartoma for pediatric epilepsy. Childs Nerv Syst 2024:10.1007/s00381-024-06595-2. [PMID: 39222089 DOI: 10.1007/s00381-024-06595-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2024] [Accepted: 08/25/2024] [Indexed: 09/04/2024]
Abstract
BACKGROUND Non-hypothalamic glioneural hamartomas are rare entities known to cause medically refractory epilepsy. Olfactory bulb hamartomas, in particular, are exceptionally rare. METHODS We describe a case of an olfactory bulb hamartoma that was surgically resected at our institution. We also performed a literature review of all glioneural hamartomas and discuss the clinical presentation, diagnosis, and management of these lesions. RESULTS Herein, we present the unusual case of a typically developing 17-year-old boy with a near life-long history of drug-resistant epilepsy, found to have a 0.8 × 1.0 cm right olfactory bulb hamartoma. Endoscopic endonasal trans-cribriform resection of the lesion led to seizure freedom in the 6-month follow-up period (Engel class 1 outcome). Comprehensive literature review revealed only one other sporadic case, which was also successfully treated with total surgical resection. CONCLUSIONS Our case of an olfactory bulb hamartoma adds to the limited literature currently available, illustrating key clinical characteristics of these exceedingly rare lesions and outlining an effective, minimally invasive, and low-morbidity treatment strategy.
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Affiliation(s)
- Adam J Kundishora
- Department of Neurosurgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
- Department of Otorhinolaryngology-Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
| | - Benjamin C Reeves
- Department of Neurosurgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - David K Lerner
- Department of Neurosurgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Otorhinolaryngology-Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Phillip B Storm
- Department of Neurosurgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Marisa S Prelack
- Department of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - James N Palmer
- Department of Neurosurgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Otorhinolaryngology-Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Nithin D Adappa
- Department of Neurosurgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Otorhinolaryngology-Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Benjamin C Kennedy
- Department of Neurosurgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA, USA
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Luisi C, Salimbene L, Pietrafusa N, Trivisano M, Marras CE, De Benedictis A, Chiarello D, Mercier M, Pepi C, de Palma L, Specchio N. Hypothalamic Hamartoma related epilepsy: A systematic review exploring clinical, neuropsychological, and psychiatric outcome after surgery. Epilepsy Behav 2024; 157:109846. [PMID: 38820683 DOI: 10.1016/j.yebeh.2024.109846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Revised: 05/15/2024] [Accepted: 05/16/2024] [Indexed: 06/02/2024]
Abstract
The post-surgical outcome for Hypothalamic Hamartoma (HH) related epilepsy in terms of seizure freedom (SF) has been extensively studied, while cognitive and psychiatric outcome has been less frequently reported and defined. This is a systematic review of English language papers, analyzing the post-surgical outcome in series of patients with HH-related epilepsy (≥5 patients, at least 6 months follow-up), published within January 2002-December 2022. SF was measured using Engel scale/equivalent scales. We looked at the outcome related to different surgical techniques, and HH types according to Delalande classification. We evaluated the neuropsychological and neuropsychiatric status after surgery, and the occurrence of post-surgical complications. Forty-six articles reporting 1318 patients were included, of which ten pediatric series. SF was reported in 686/1222 patients (56,1%). Delalande classification was reported in 663 patients from 24 studies, of which 70 were type I HH (10%), 320 were type II HH (48%), 189 were type III HH (29%) and 84 were type IV HH (13%). The outcome in term of SF was reported in 243 out of 663 patients. SF was reported in 12 of 24 type I HH (50%), 80 of 132 type II HH (60,6%), 32 of 59 type III HH (54,2%) and 12 of 28 type IV HH (42,9%). SF was reached in 129/262 (49,2%) after microsurgery, 102/199 (51,3%) after endoscopic surgery, 46/114 (40,6%) after gamma knife surgery, 245/353 (69,4%) after radiofrequency thermocoagulation, and 107/152 (70,4%) after MRI-guided laser interstitial thermal therapy. Hyperphagia/weight gain were the most reported surgical complications. Others were electrolyte alterations, diabetes insipidus, hypotiroidism, transient hyperthermia/poikilothermia. The highest percentage of memory deficits was reported after microsurgery, while hemiparesis and cranial nerves palsy were reported after microsurgery or endoscopic surgery. Thirty studies reported developmental delay/intellectual disability in 424/819 (51,7%) patients. 248/346 patients obtained a global improvement (72%), 70/346 were stable (20%), 28/346 got worse (8%). 22 studies reported psychiatric disorders in 257/465 patients (55,3%). 78/98 patients improved (80%), 13/98 remained stable (13%), 7/98 got worse (7%). Most of the patients had non-structured cognitive/psychiatric assessments. Based on the available data, the surgical management in patients with HH related epilepsy should be individualized, aiming to reach not only the best epilepsy result, but also the optimal cognitive and psychiatric outcome.
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Affiliation(s)
- Concetta Luisi
- Neurology, Epilepsy and Movement Disorders Unit, Bambino Gesù Children's Hospital, IRCCS, Full Member of European Reference Network on Rare and Complex Epilepsies, EpiCARE, Rome, Italy
| | - Licia Salimbene
- Neurology, Epilepsy and Movement Disorders Unit, Bambino Gesù Children's Hospital, IRCCS, Full Member of European Reference Network on Rare and Complex Epilepsies, EpiCARE, Rome, Italy
| | - Nicola Pietrafusa
- Neurology, Epilepsy and Movement Disorders Unit, Bambino Gesù Children's Hospital, IRCCS, Full Member of European Reference Network on Rare and Complex Epilepsies, EpiCARE, Rome, Italy
| | - Marina Trivisano
- Neurology, Epilepsy and Movement Disorders Unit, Bambino Gesù Children's Hospital, IRCCS, Full Member of European Reference Network on Rare and Complex Epilepsies, EpiCARE, Rome, Italy
| | | | | | - Daniela Chiarello
- Neurology, Epilepsy and Movement Disorders Unit, Bambino Gesù Children's Hospital, IRCCS, Full Member of European Reference Network on Rare and Complex Epilepsies, EpiCARE, Rome, Italy
| | - Mattia Mercier
- Neurology, Epilepsy and Movement Disorders Unit, Bambino Gesù Children's Hospital, IRCCS, Full Member of European Reference Network on Rare and Complex Epilepsies, EpiCARE, Rome, Italy
| | - Chiara Pepi
- Neurology, Epilepsy and Movement Disorders Unit, Bambino Gesù Children's Hospital, IRCCS, Full Member of European Reference Network on Rare and Complex Epilepsies, EpiCARE, Rome, Italy
| | - Luca de Palma
- Neurology, Epilepsy and Movement Disorders Unit, Bambino Gesù Children's Hospital, IRCCS, Full Member of European Reference Network on Rare and Complex Epilepsies, EpiCARE, Rome, Italy
| | - Nicola Specchio
- Neurology, Epilepsy and Movement Disorders Unit, Bambino Gesù Children's Hospital, IRCCS, Full Member of European Reference Network on Rare and Complex Epilepsies, EpiCARE, Rome, Italy.
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Graffeo CS, Kotecha R, Sahgal A, Fariselli L, Gorgulho A, Levivier M, Ma L, Paddick I, Regis J, Sheehan JP, Suh JH, Yomo S, Pollock BE. Stereotactic Radiosurgery for Intermediate (III) or High (IV-V) Spetzler-Martin Grade Arteriovenous Malformations: International Stereotactic Radiosurgery Society Practice Guideline. Neurosurgery 2024:00006123-990000000-01279. [PMID: 38989995 DOI: 10.1227/neu.0000000000003102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Accepted: 05/29/2024] [Indexed: 07/12/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Consensus guidelines do not exist to guide the role of stereotactic radiosurgery (SRS) in the management of patients with Spetzler-Martin Grade III-V arteriovenous malformations (AVMs). We sought to establish SRS practice guidelines for Grade III-V AVMs based on a critical systematic review of the published literature. METHODS A Preferred Reporting Items for Systematic Reviews and Meta-Analyses-compliant search of Medline, Embase, and Scopus, 1986 to 2023, for publications reporting post-SRS outcomes in ≥10 Grade III-V AVMs with the median follow-up ≥24 months was performed. Primary end points were AVM obliteration and post-SRS hemorrhage. Secondary end points included dosimetric variables, Spetzler-Martin parameters, and neurological outcome. RESULTS : In total, 2463 abstracts were screened, 196 manuscripts were reviewed, and 9 met the strict inclusion criteria. The overall sample of 1634 AVMs consisted of 1431 Grade III (88%), 186 Grade IV (11%), and 11 Grade V lesions (1%). Total median post-SRS follow-up was 53 months for Grade III and 43 months for Grade IV-V AVMs (ranges, 2-290; 12-262). For Grade III AVMs, the crude obliteration rate was 72%, and among Grade IV-V lesions, the crude obliteration rate was 46%. Post-SRS hemorrhage was observed in 7% of Grade III compared with 17% of Grade IV-V lesions. Major permanent deficits or death from hemorrhage or radiation-induced complications occurred in 86 Grade III (6%) and 22 Grade IV-V AVMs (12%). CONCLUSION Most patients with Spetzler-Martin Grade III AVMs have favorable SRS treatment outcomes; however, the obliteration rate for Grade IV-V AVMs is less than 50%. The available studies are heterogenous and lack nuanced, long-term, grade-specific outcomes.
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Affiliation(s)
- Christopher S Graffeo
- Department of Neurological Surgery, University of Oklahoma, Oklahoma City, Oklahoma, USA
| | - Rupesh Kotecha
- Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, Florida, USA
| | - Arjun Sahgal
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Laura Fariselli
- Department of Neurosurgery, Unit of Radiotherapy, Fondazione IRCCS Istituto Neurologico C Besta, Milan, Italy
| | - Alessandra Gorgulho
- Department of Neurosurgery, State University of São Paulo, NeuroSapiens Group, São Paulo, Brazil
- D'Or Institute for Research and Education, São Paulo, Brazil
| | - Marc Levivier
- Department of Clinical Neurosciences, Neurosurgery Service and Gamma Knife Center, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Lijun Ma
- Department of Radiation Oncology, University of Southern California, Los Angeles, California, USA
| | - Ian Paddick
- Queen Square Radiosurgery Centre, National Hospital for Neurology and Neurosurgery, London, UK
| | - Jean Regis
- Aix-Marseille Université, Institut National de la Santé et de la Recherche Médicale, Institut de Neurosciences des Systèmes (INS) UMR1106, Marseille, France
| | - Jason P Sheehan
- Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - John H Suh
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Shoji Yomo
- Division of Radiation Oncology, Aizawa Comprehensive Cancer Center, Aizawa Hospital, Matsumoto, Japan
| | - Bruce E Pollock
- Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota, USA
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Tripathi M, Sheehan JP, Niranjan A, Ren L, Pikis S, Lunsford LD, Peker S, Samanci Y, Langlois AM, Mathieu D, Lee CC, Yang HC, Deng H, Rai A, Kumar N, Sahu JK, Sankhyan N, Deora H. Gamma Knife Radiosurgery for Hypothalamic Hamartoma: A Multi-Institutional Retrospective Study on Safety, Efficacy, and Complication Profile. Neurosurgery 2024:00006123-990000000-01280. [PMID: 38990006 DOI: 10.1227/neu.0000000000003110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 05/23/2024] [Indexed: 07/12/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Gamma knife radiosurgery (GKRS) is a safe and effective treatment option for hypothalamic hamartomas (HH), but there is no consensus opinion on its timing, dosage, and follow-up. The aim of this study was to define the safety, efficacy, outcome, and complication profile of GKRS in this patient population. METHODS This retrospective multicentric study involved 39 patients with the mean age of 16 ± 14.84 years. Early seizures resulted in an earlier age of diagnosis in 97% of patients. At baseline, no endocrine abnormalities were seen in 75% of patients while 18.9% showed precocious puberty (PP). The median target volume was 0.55 cc (0.1-10.00 cc), and a median margin dose of 16 Gy (8.1-20.0 Gy) was delivered in a single session. All patients were evaluated for clinical, endocrinological, and radiological outcomes. RESULTS The median follow-up was 5 (0.1-15) years. The median target volume of the cohort was 0.55 (0.35-1.77) cc. The largest HH was of 10 cc. 24/39 (61.5%) were small HH (Regis I-III). At presentation, 94.8% patients suffered from seizures (87.18% with gelastic seizures). 7/39 patients (17.9%) were presented with both PP and epilepsy. Only one (2.6%) patient presented with PP alone. 29 patients had more than 3-year follow-up. All received ≥16 Gy targeting complete HH. 28% of patients showed regression in HH volume. Patients with Regis grade I-III and longer follow-up (>75 months) showed gradual improvement in seizures. 16/29 patients (55.2%) achieved good seizure control (Engel I/II) while 13 (44.8%) were in Engel III/IV status. Nine patients needed adjuvant treatment because of poor seizure control. Eight patients suffered from transient increase in seizures. One patient developed poikilothermia, and 2 patients developed new onset hormonal deficiency. CONCLUSION GKRS is a safe and effective modality for treatment of HH with significant improvement in seizure control with minimal disruption of endocrine profile. It provides an excellent safety, efficacy, and complication profile, especially for small HH. Latency of results and its adjuvant nature remain the areas of research and breakthroughs among contemporary treatment options.
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Affiliation(s)
- Manjul Tripathi
- Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Jason P Sheehan
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Ajay Niranjan
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Lydia Ren
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Stylianos Pikis
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia, USA
| | - L Dade Lunsford
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Selcuk Peker
- Department of Neurosurgery, Koc University School of Medicine, Istanbul, Turkey
| | - Yavuz Samanci
- Department of Neurosurgery, Koc University School of Medicine, Istanbul, Turkey
| | - Anne Marie Langlois
- Department of Neurosurgery, Centre de recherche du CHUS, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - David Mathieu
- Department of Neurosurgery, Centre de recherche du CHUS, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Cheng Chia Lee
- Department of Neurosurgery, School of Medicine, Neurological Institute, Taipei Veteran General Hospital, Taipei, Taiwan
- National Yang Ming Chiao Tung University, Hsinchu, Taiwan
| | - Huai Che Yang
- Department of Neurosurgery, School of Medicine, Neurological Institute, Taipei Veteran General Hospital, Taipei, Taiwan
- National Yang Ming Chiao Tung University, Hsinchu, Taiwan
| | - Hansen Deng
- Department of Neurosurgery, School of Medicine, Neurological Institute, Taipei Veteran General Hospital, Taipei, Taiwan
- National Yang Ming Chiao Tung University, Hsinchu, Taiwan
| | - Ashutosh Rai
- Department of Endocrinology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
- Centre for Endocrinology, William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Narendra Kumar
- Department of Radiotherapy, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Jitendra Kuma Sahu
- Pediatric Neurology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Naveen Sankhyan
- Pediatric Neurology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Harsh Deora
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bengaluru, India
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Ou Y, Yuan J, Li C. Direct resection is a safe and effective strategy to control seizures in patients with hypothalamic hamartoma. Sci Rep 2024; 14:13001. [PMID: 38844500 PMCID: PMC11156988 DOI: 10.1038/s41598-024-63480-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 05/29/2024] [Indexed: 06/09/2024] Open
Abstract
Achieving favorable seizure outcomes is challenging in patients with seizures resulting from hypothalamic hamartoma. Although minimally invasive and non-invasive surgical procedures are used to treat this population, these procedures have limitations. Therefore, we analyzed the outcomes of patients with hypothalamic hamartoma following direct resection. We included 159 patients with hypothalamic hamartoma who underwent direct resection using the transcallosal interforniceal approach between 2011 and 2018. The relationships between clinical parameters and seizure outcomes were analyzed. In total, 55.3% achieved gross total resection and 25.2% underwent near-total resection. Of all patients, 79.2% were overall seizure-free at one year, but this number dropped to 77.0% at more than five years. Moreover, 88.4% (129/146) reached gelastic seizure (GS)-free status at one year and this number increased to 89.0% (97/109) at more than five years. Seventy-one patients took antiseizure medication (ASM) long-term, 68 took it for one year, and 11 took it for one-half year. The duration of ASM consumption (p < 0.001) and extent of hypothalamic hamartoma resection (p = 0.016) were significant independent predictors of long-term overall seizure-free survival, while the duration of ASM consumption (p = 0.011) and extent of hypothalamic hamartoma resection (p = 0.026) were significant independent predictors of long-term GS-free survival. Most patients' behavior, school performance, and intelligence were not affected after surgery. Direct resection is effective and safe strategy for patients with hypothalamic hamartomas. Hypothalamic hamartomas should be removed as completely as possible, and patients should take ASM long-term following surgery to reach long-term overall seizure-free or GS-free status.
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Affiliation(s)
- Yunwei Ou
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
- The Institute of Artificial Intelligence, Hefei Comprehensive National Science Center, Hefei, Anhui, China.
- Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, Beihang University, Beijing, China.
- China National Clinical Research Center for Neurological Diseases, Beijing, China.
| | - Jingzhe Yuan
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- The Institute of Artificial Intelligence, Hefei Comprehensive National Science Center, Hefei, Anhui, China
- Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, Beihang University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Chunde Li
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
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Jaramillo-Jiménez E, Sandoval-Barrios J, Walsh FJ, Jaramillo-Jiménez MC, Echeverri-Sánchez JD, Rodríguez-Márquez IA, Barrientos-Montoya HD, Ascencio-Lancheros JL, Giraldo-Palacio JF, Sierra-Arrieta IM, Gómez-Duque DI, Pérez-López S, Bustamante MT. Epileptic encephalopathies secondary to hypothalamic hamartomas treated with radiosurgery: A case series. Epileptic Disord 2024. [PMID: 38804823 DOI: 10.1002/epd2.20246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 05/08/2024] [Accepted: 05/13/2024] [Indexed: 05/29/2024]
Abstract
OBJECTIVE Hypothalamic hamartomas are congenital lesions that typically present with gelastic seizures, refractory epilepsy, neurodevelopmental delay, and severe cognitive impairment. Surgical procedures have been reported to be effective in removing the hamartomas, however, they are associated with significant morbidity. Therefore, it is not considered a safe therapeutic modality. Image-guided robotic radiosurgery (CyberKnife® Radiosurgery System) has been shown to provide good outcomes without lasting complications. METHODS This series of cases describes the clinical, radiological, radiotherapeutic, and postsurgical outcomes of five patients with epileptic encephalopathies secondary to hypothalamic hamartomas who were treated with CyberKnife®. RESULTS All patients exhibited refractory epilepsy with gelastic seizures and were unsuitable candidates for surgical resection The prescribed dose ranged between 16 and 25 Gy, delivered in a single fraction for four patients and five fractions for one patient while adhering strictly to visual pathway constraints. After radiosurgery, four patients maintained seizure control (one with an Engel class Ia, three with an Engel class 1d), and another presented sporadic, nondisabling gelastic seizures (with an Engel class IIa). After 24-26 months of follow-up, in three patients, their intelligence quotient scores increased. No complications were reported. SIGNIFICANCE This report suggests that Cyberknife may be a good option for treating hypothalamic hamartoma, particularly in cases where other noninvasive alternatives are unavailable. Nevertheless, additional studies are essential in order to evaluate the effectiveness of the technique in these cases.
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Affiliation(s)
| | | | - Fergus John Walsh
- School of Medicine, College of Health & Medicine, University of Tasmania, Hobart, Tasmania, Australia
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Karakis I. No More Tears: Surgical Options and Outcomes in Hypothalamic Hamartomas. Epilepsy Curr 2024; 24:22-24. [PMID: 38327529 PMCID: PMC10846512 DOI: 10.1177/15357597231211708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2024] Open
Abstract
Long Term Outcome After Surgical Treatment for Hypothalamic Hamartoma Kulkarni N, Nageotte RA, Klamer BG, Rekate HL, Bristol RE, Scharnweber T, Bobrowitz M, Kerrigan JF. Epilepsy Res . 2023;195:107186. doi:10.1016/j.eplepsyres.2023.107186 . PMID: 37454523 Purpose: To determine long-term outcome for seizure control and clinical predictors for seizure freedom in patients undergoing surgical treatment for epilepsy associated with hypothalamic hamartoma (HH). Methods: 155 patients underwent surgical treatment for HHs and treatment-resistant epilepsy at one center (Barrow Neurological Institute at St. Joseph’s Hospital and Medical Center, Phoenix, Arizona, USA) between February 2003 and June 2010. Data collection included medical record review and direct follow-up interviews to determine seizure outcome. Statistical analysis included descriptive summaries of patient characteristics and time-to-event analysis for seizure freedom. Results: Long-term survival with follow-up of at least five years since first surgical treatment was available for 108 patients (69.7% of the treatment cohort). The surgical approach for first HH intervention consisted of transventricular endoscopic resection (n = 57; 52.8%), transcallosal interforniceal resection (n = 35; 32.4%), pterional resection (n = 7; 6.5%), and gamma knife radiosurgery (n = 9; 8.3%). Multiple surgical procedures were required for 39 patients (36.1%). There were 10 known deaths from all causes in the treatment cohort (6.5%). Of these, one (0.6%) was related to immediate complications of HH surgery, three (1.9%) were attributed to Sudden Unexpected Death in Epileptic Persons (SUDEP), and one (0.6%) to complications of status epilepticus. For surviving patients with long-term follow-up, 55 (50.9%) were seizure-free for all seizure types. Univariable analysis showed that seizure-freedom was related to 1) absence of a pre-operative history for central precocious puberty (p = 0.01), and 2) higher percentage of HH lesion disconnection after surgery (p = 0.047). Kaplan-Meier survival analysis shows that long-term seizure outcome following HH surgery is comparable to short-term results. Summary: These uncontrolled observational results show that long-term seizure control following HH surgical treatment is comparable to other forms of epilepsy surgery. Late relapse (at least one year after surgery) and SUDEP do occur, but in a relatively small number of treated patients. These results inform clinical practice and serve as a comparable benchmark for newer technologies for HH surgery, such as magnetic resonance imaging-guided laser interstitial thermal therapy, where long-term outcome results are not yet available. Epilepsy Surgery in Patients With Hypothalamic Hamartomas—Population-Based Two-Year and Long-Term Outcomes Hahne O, Rydenhag B, Tranberg AE, Kristjánsdóttir R, Nilsson D, Olsson I, Hallböök T. Eur J Paediatr Neurol . 2023;46:24-29. doi:10.1016/j.ejpn.2023.06.004 . PMID: 37385151 Objective: Hypothalamic hamartomas are benign lesions associated with drug resistant epilepsy. Surgical treatment has become an increasingly utilised approach with promising results. This study aims to evaluate seizure outcome and complications after surgery in a population-based series of patients with intractable epilepsy and hypothalamic hamartoma. Methods: All patients with hypothalamic hamartoma treated with epilepsy surgery in Sweden since 1995 with at least two years of follow-up were included. Preoperative, two-, five- and ten-year prospective longitudinal data were collected from The Swedish National Epilepsy Surgery Register. Data included seizure types and frequency, duration of epilepsy, clinical characteristics, neurological deficits, cognitive level and complications. In a subgroup from Gothenburg, we also analysed data not included in the register such as classification of hamartomas, surgical procedures and gelastic seizures. Results: Eighteen patients were operated on during the period 1995-2020. The median age at epilepsy onset was 6 months and age at surgery 13 years. Four were seizure free and another four had ≥75% reduction in seizure frequency at the two-year follow-up. Two of the 13 patients with a long-term follow-up (five or ten years) were seizure-free and four had ≥75% reduction in seizure frequency. Three had an increased seizure frequency. No major complications were seen. Five had minor complications. In the Gothenburg subgroup all had open pterional disconnection or intraventricular endoscopic disconnection. Six of 12 were free from gelastic seizures at the two-year follow-up and six of eight at the long-term follow-up. Conclusion: This study supports surgical treatment of hypothalamic hamartomas as a safe method with a low risk of permanent complications. The seizure reduction seems to be persistent over time.
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Affiliation(s)
- Ioannis Karakis
- Department of Neurology, Emory University School of Medicine University of Crete School of Medicine
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Hinojosa J, Candela-Cantó S, Becerra V, Muchart J, Gómez-Chiari M, Rumia J, Aparicio J. Multimodal Approach for the Treatment of Complex Hypothalamic Hamartomas. Adv Tech Stand Neurosurg 2024; 50:119-145. [PMID: 38592529 DOI: 10.1007/978-3-031-53578-9_4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/10/2024]
Abstract
Hypothalamic hamartomas (HHs) are rare congenital lesions formed by heterotopic neuronal and glial cells attached to the mammillary bodies, tuber cinereum, and hypothalamus.They often present with an intractable epilepsy typically characterized by gelastic seizures but commonly associated with other types of refractory seizures. The clinical course is progressive in most of the cases, starting with gelastic seizures in infancy and deteriorating into complex seizure disorders that result in catastrophic epilepsy associated with cognitive decline and behavioral disturbances.Hamartomas are known to be intrinsically epileptogenic and the site of origin for the gelastic seizures. As antiepileptic drugs are typically ineffective in controlling HH-related epilepsy, different surgical options have been proposed as a treatment to achieve seizure control. Resection or complete disconnection of the hamartoma from the mammillothalamic tract has proved to achieve a long-lasting control of the epileptic syndrome.Usually, symptoms and their severity are typically related to the size, localization, and type of attachment. Precocious puberty appears mostly in the pedunculated type, while epileptic syndrome and behavioral decline are frequently related to the sessile type. For this reason, different classifications of HHs have been developed based on their size, extension, and type of attachment to the hypothalamus.The bigger and more complex hypothalamic hamartomas typically present with severe refractory epilepsy, behavioral disturbances, and progressive cognitive decline posing a formidable challenge for the control of these symptoms.We present here our experience with the multimodal treatment for complex hypothalamic hamartomas. After an in-depth review of the literature, we systematize our approach for the different types of hypothalamic hamartomas.
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Affiliation(s)
- José Hinojosa
- Department of Neurosurgery, Hospital Sant Joan de Déu, Barcelona, Spain.
- Unit for Epilepsy Surgery, Hospital Sant Joan de Déu, Barcelona, Spain.
| | - Santiago Candela-Cantó
- Department of Neurosurgery, Hospital Sant Joan de Déu, Barcelona, Spain
- Unit for Epilepsy Surgery, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Victoria Becerra
- Department of Neurosurgery, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Jordi Muchart
- Unit for Epilepsy Surgery, Hospital Sant Joan de Déu, Barcelona, Spain
- Department of Diagnostic Imaging, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Marta Gómez-Chiari
- Unit for Epilepsy Surgery, Hospital Sant Joan de Déu, Barcelona, Spain
- Department of Diagnostic Imaging, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Jordi Rumia
- Department of Neurosurgery, Hospital Sant Joan de Déu, Barcelona, Spain
- Unit for Epilepsy Surgery, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Javier Aparicio
- Unit for Epilepsy Surgery, Hospital Sant Joan de Déu, Barcelona, Spain
- Department of Neurology, Hospital Sant Joan de Déu, Barcelona, Spain
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Rizzi M, Nichelatti M, Ferri L, Consales A, De Benedictis A, Cossu M. Seizure outcomes and safety profiles of surgical options for epilepsy associated to hypothalamic hamartomas. A systematic review and meta-analysis. Epilepsy Res 2023; 198:107261. [PMID: 38006630 DOI: 10.1016/j.eplepsyres.2023.107261] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Revised: 11/02/2023] [Accepted: 11/16/2023] [Indexed: 11/27/2023]
Abstract
PURPOSE Several surgical options are available for treating hypothalamic hamartoma-related epilepsy but their respective efficacy and safety profiles are poorly defined. METHODS A literature search identified English-language articles reporting series of patients (minimum 3 patients with a follow-up ≥12 months) operated on by either microsurgery, endoscopic surgery, radiosurgery, radiofrequency thermocoagulation or laser interstitial thermal therapy for hypothalamic hamartoma-related epilepsy. The unit of analysis was each selected study. Pooled rates of seizure freedom and of neurological and endocrinological complications were analyzed using meta-analysis to calculate both fixed and random effects. The results of meta-analyses were compared. RESULTS Thirty-nine studies were included. There were 568 and 514 participants for seizure outcome and complication analyses, respectively. The pairwise comparison showed that: i) the proportion of seizure-free cases was significantly lower for radiosurgery as compared to microsurgery, radiofrequency thermocoagulation and laser ablation, and significantly lower for endoscopic surgery as compared to radiofrequency thermocoagulation; ii) the proportion of permanent hypothalamic dysfunction was significantly higher for microsurgery as compared to all other techniques, and significantly lower for endoscopic surgery as compared to radiofrequency thermocoagulation and laser ablation; iii) the incidence of permanent neurological disorders was significantly higher for microsurgery as compared to endoscopic surgery, radiosurgery and radiofrequency thermocoagulation, and significantly lower for radiosurgery as compared to laser ablation. CONCLUSIONS Minimally invasive surgical techniques, including endoscopic surgery, radiofrequency thermocoagulation and laser ablation, represent an acceptable compromise between efficacy and safety in the treatment of hypothalamic hamartoma-related epilepsy. Microsurgery and radiosurgery should be considered in carefully selected cases.
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Affiliation(s)
- Michele Rizzi
- Functional Neurosurgery Unit and Epilepsy Surgery Program, Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico "Carlo Besta", Milan, Italy.
| | - Michele Nichelatti
- Service of Biostatistics, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Lorenzo Ferri
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | | | - Alessandro De Benedictis
- Neurosurgery Unit, Department of Neurosciences, Bambino Gesù Children Hospital IRCCS, Rome, Italy
| | - Massimo Cossu
- Neurosurgery Unit, Giannina Gaslini Pediatric Hospital IRCCS, Genoa, Italy
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11
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Tomita T. The evolution of pediatric neurosurgery: reflection of personal experience of the last half-century. Childs Nerv Syst 2023; 39:2571-2582. [PMID: 37486438 DOI: 10.1007/s00381-023-06068-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Accepted: 07/05/2023] [Indexed: 07/25/2023]
Abstract
OBJECTIVES In the past 50 years, pediatric neurosurgery has made tremendous strides, and gained its own identity as a distinct subspecialty. I have personally observed this progress and evolution in pediatric neurosurgery in multiple dimensions, which are described based upon my own experience and reflection. METHODS The development and evolutions of multiple domains of pediatric neurosurgery, including neuroimaging, hydrocephalus, pediatric brain tumor, spinal dysraphism, craniosynostosis, vascular malformation, functional neurosurgery and spinal disorders were reviewed and commented on based upon my own experience and reflection. RESULTS The field of pediatric neurosurgery has grown in all aspects of diagnosis and therapy owing to the introduction of computers, innovative techniques and technologies and new discoveries of scientific data including molecular investigations. CONCLUSION A minimally invasive approach and molecular target therapy are a current trend. The past half century's clinical experience and advances in biomedical knowledge and techniques provide foundation for further improvement in the care of children of the next generation. Prospective artificial intelligence will likely promote further advances in pediatric neurosurgery.
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Affiliation(s)
- Tadanori Tomita
- Division of Pediatric Neurosurgery, Department of Neurological Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, 225 E. Chicago Avenue, Chicago, Illinois, 60611, USA.
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12
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Hahne O, Rydenhag B, Tranberg AE, Kristjánsdóttir R, Nilsson D, Olsson I, Hallböök T. Epilepsy surgery in patients with hypothalamic hamartomas - Population-based two-year and long-term outcomes. Eur J Paediatr Neurol 2023; 46:24-29. [PMID: 37385151 DOI: 10.1016/j.ejpn.2023.06.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 04/30/2023] [Accepted: 06/16/2023] [Indexed: 07/01/2023]
Abstract
OBJECTIVE Hypothalamic hamartomas are benign lesions associated with drug resistant epilepsy. Surgical treatment has become an increasingly utilised approach with promising results. This study aims to evaluate seizure outcome and complications after surgery in a population-based series of patients with intractable epilepsy and hypothalamic hamartoma. METHODS All patients with hypothalamic hamartoma treated with epilepsy surgery in Sweden since 1995 with at least two years of follow-up were included. Preoperative, two-, five- and ten-year prospective longitudinal data were collected from The Swedish National Epilepsy Surgery Register. Data included seizure types and frequency, duration of epilepsy, clinical characteristics, neurological deficits, cognitive level and complications. In a subgroup from Gothenburg, we also analysed data not included in the register such as classification of hamartomas, surgical procedures and gelastic seizures. RESULTS Eighteen patients were operated on during the period 1995-2020. The median age at epilepsy onset was 6 months and age at surgery 13 years. Four were seizure free and another four had ≥75% reduction in seizure frequency at the two-year follow-up. Two of the 13 patients with a long-term follow-up (five or ten years) were seizure-free and four had ≥75% reduction in seizure frequency. Three had an increased seizure frequency. No major complications were seen. Five had minor complications. In the Gothenburg subgroup all had open pterional disconnection or intraventricular endoscopic disconnection. Six of 12 were free from gelastic seizures at the two-year follow-up and six of eight at the long-term follow-up. CONCLUSION This study supports surgical treatment of hypothalamic hamartomas as a safe method with a low risk of permanent complications. The seizure reduction seems to be persistent over time.
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Affiliation(s)
- Oscar Hahne
- Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden; Member of the ERN, EpiCARE, Gothenburg, Sweden.
| | - Bertil Rydenhag
- Member of the ERN, EpiCARE, Gothenburg, Sweden; Department of Neurosurgery, Sahlgrenska University Hospital, Gothenburg, Sweden; Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Anna Edelvik Tranberg
- Member of the ERN, EpiCARE, Gothenburg, Sweden; Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden.
| | - Ragnhildur Kristjánsdóttir
- Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Member of the ERN, EpiCARE, Gothenburg, Sweden; Habilitation & Health, Gothenburg, Sweden.
| | - Daniel Nilsson
- Member of the ERN, EpiCARE, Gothenburg, Sweden; Department of Neurosurgery, Sahlgrenska University Hospital, Gothenburg, Sweden; Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Ingrid Olsson
- Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden; Member of the ERN, EpiCARE, Gothenburg, Sweden.
| | - Tove Hallböök
- Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden; Member of the ERN, EpiCARE, Gothenburg, Sweden.
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13
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Simmons G, Gallitto M, Lee A, Baltuch G, Youngerman BE, Wang TJC. The Use of Stereotactic Radiosurgery to Treat Functional Disorders: A Topic Discussion. Pract Radiat Oncol 2023; 13:e395-e399. [PMID: 37263538 DOI: 10.1016/j.prro.2023.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 04/25/2023] [Accepted: 05/02/2023] [Indexed: 06/03/2023]
Abstract
Stereotactic radiosurgery (SRS) is a well-known modality for the treatment of malignant brain tumors. SRS, however, can also be used to treat non-malignant functional disorders such as epilepsy, tremor, trigeminal neuralgia (TN), obsessive compulsive disorder (OCD), and intractable pain among others. Given the limited prospective data guiding treatment of these benign disorders, this article serves as a consolidated discussion of the application of SRS for functional ailments, hopefully serving as a reference for those considering application of this technique in clinical practice.
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Affiliation(s)
- Grace Simmons
- Department of Radiation Oncology, Columbia University Irving Medical Center, New York, New York
| | - Matthew Gallitto
- Department of Radiation Oncology, Columbia University Irving Medical Center, New York, New York
| | - Albert Lee
- Department of Radiation Oncology, Columbia University Irving Medical Center, New York, New York
| | - Gordon Baltuch
- Department of Neurological Surgery, Columbia University Irving Medical Center, New York, New York
| | - Brett E Youngerman
- Department of Neurological Surgery, Columbia University Irving Medical Center, New York, New York
| | - Tony J C Wang
- Department of Radiation Oncology, Columbia University Irving Medical Center, New York, New York.
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14
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Green TE, Fujita A, Ghaderi N, Heinzen EL, Matsumoto N, Klein KM, Berkovic SF, Hildebrand MS. Brain mosaicism of hedgehog signalling and other cilia genes in hypothalamic hamartoma. Neurobiol Dis 2023; 185:106261. [PMID: 37579995 DOI: 10.1016/j.nbd.2023.106261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 08/02/2023] [Accepted: 08/11/2023] [Indexed: 08/16/2023] Open
Abstract
Hypothalamic hamartoma (HH) is a rare benign developmental brain lesion commonly associated with a well characterized epilepsy phenotype. Most individuals with HH are non-syndromic without additional developmental anomalies nor a family history of disease. Nonetheless, HH is a feature of Pallister-Hall (PHS) and Oro-Facial-Digital Type VI (OFD VI) syndromes, both characterized by additional developmental anomalies. Initial genetic of analysis HH began with syndromic HH, where germline inherited or de novo variants in GLI3, encoding a central transcription factor in the sonic hedgehog (Shh) signalling pathway, were identified in most individuals with PHS. Following these discoveries in syndromic HH, the hypothesis that post-zygotic mosaicism in related genes may underly non-syndromic HH was tested. We discuss the identified mosaic variants within individuals with non-syndromic HH, review the analytical methodologies and diagnostic yields, and explore understanding of the functional role of the implicated genes with respect to Shh signalling, and cilia development and function. We also outline future challenges in studying non-syndromic HH and suggest potential novel strategies to interrogate brain mosaicism in HH.
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Affiliation(s)
- Timothy E Green
- Epilepsy Research Centre, Department of Medicine, The University of Melbourne, Austin Health, Heidelberg, Victoria 3084, Australia
| | - Atsushi Fujita
- Department of Human Genetics, Yokohama City University Graduate School of Medicine, Yokohama 236-0004, Japan
| | - Navid Ghaderi
- Departments of Clinical Neurosciences, Medical Genetics and Community Health Sciences, Hotchkiss Brain Institute & Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Canada
| | - Erin L Heinzen
- Eshelman School of Pharmacy, Division of Pharmacotherapy and Experimental Therapeutics, Department of Genetics, University of North Carolina, Chapel Hill, NC, USA
| | - Naomichi Matsumoto
- Department of Human Genetics, Yokohama City University Graduate School of Medicine, Yokohama 236-0004, Japan
| | - Karl Martin Klein
- Departments of Clinical Neurosciences, Medical Genetics and Community Health Sciences, Hotchkiss Brain Institute & Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Canada; Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, Goethe University and University Hospital Frankfurt, Frankfurt am Main, Germany; LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Samuel F Berkovic
- Epilepsy Research Centre, Department of Medicine, The University of Melbourne, Austin Health, Heidelberg, Victoria 3084, Australia
| | - Michael S Hildebrand
- Epilepsy Research Centre, Department of Medicine, The University of Melbourne, Austin Health, Heidelberg, Victoria 3084, Australia; Murdoch Children's Research Institute, The Royal Children's Hospital, Parkville, Victoria, Australia.
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15
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Chen JS, Lamoureux AA, Shlobin NA, Elkaim LM, Wang A, Ibrahim GM, Obaid S, Harroud A, Guadagno E, Dimentberg E, Bouthillier A, Bernhardt BC, Nguyen DK, Fallah A, Weil AG. Magnetic resonance-guided laser interstitial thermal therapy for drug-resistant epilepsy: A systematic review and individual participant data meta-analysis. Epilepsia 2023; 64:1957-1974. [PMID: 36824029 DOI: 10.1111/epi.17560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 01/30/2023] [Accepted: 02/22/2023] [Indexed: 02/25/2023]
Abstract
Magnetic resonance-guided laser interstitial thermal therapy (MRgLITT) has emerged as a popular minimally invasive alternative to open resective surgery for drug-resistant epilepsy (DRE). We sought to perform a systematic review and individual participant data meta-analysis to identify independent predictors of seizure outcome and complications following MRgLITT for DRE. Eleven databases were searched from January 1, 2010 to February 6, 2021 using the terms "MR-guided ablation therapy" and "epilepsy". Multivariable mixed-effects Cox and logistic regression identified predictors of time to seizure recurrence, seizure freedom, operative complications, and postoperative neurological deficits. From 8705 citations, 46 studies reporting on 450 MRgLITT DRE patients (mean age = 29.5 ± 18.1 years, 49.6% female) were included. Median postoperative seizure freedom and follow-up duration were 15.5 and 19.0 months, respectively. Overall, 240 (57.8%) of 415 patients (excluding palliative corpus callosotomy) were seizure-free at last follow-up. Generalized seizure semiology (hazard ratio [HR] = 1.78, p = .020) and nonlesional magnetic resonance imaging (MRI) findings (HR = 1.50, p = .032) independently predicted shorter time to seizure recurrence. Cerebral cavernous malformation (CCM; odds ratio [OR] = 7.97, p < .001) and mesial temporal sclerosis/atrophy (MTS/A; OR = 2.21, p = .011) were independently associated with greater odds of seizure freedom at last follow-up. Operative complications occurred in 28 (8.5%) of 330 patients and were independently associated with extratemporal ablations (OR = 5.40, p = .012) and nonlesional MRI studies (OR = 3.25, p = .017). Postoperative neurological deficits were observed in 53 (15.1%) of 352 patients and were independently predicted by hypothalamic hamartoma etiology (OR = 5.93, p = .006) and invasive electroencephalographic monitoring (OR = 4.83, p = .003). Overall, MRgLITT is particularly effective in treating patients with well-circumscribed lesional DRE, such as CCM and MTS/A, but less effective in nonlesional cases or lesional cases with a more diffuse epileptogenic network associated with generalized seizures. This study identifies independent predictors of seizure freedom and complications following MRgLITT that may help further guide patient selection.
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Affiliation(s)
- Jia-Shu Chen
- Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
| | - Audrey-Anne Lamoureux
- Division of Pediatric Neurosurgery, Department of Surgery, Sainte Justine Hospital, University of Montreal, Montreal, Quebec, Canada
| | - Nathan A Shlobin
- Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Lior M Elkaim
- Division of Neurology and Neurosurgery, McGill University, Montreal, Quebec, Canada
| | - Andrew Wang
- Department of Neurosurgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA
| | - George M Ibrahim
- Division of Neurosurgery, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Sami Obaid
- Division of Pediatric Neurosurgery, Department of Surgery, Sainte Justine Hospital, University of Montreal, Montreal, Quebec, Canada
- Division of Neurosurgery, University of Montreal Hospital Center, Montreal, Quebec, Canada
| | - Adil Harroud
- Division of Neurology and Neurosurgery, McGill University, Montreal, Quebec, Canada
- Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada
| | - Elena Guadagno
- Harvey E. Beardmore Division of Pediatric Surgery, McGill University Health Center, Montreal, Quebec, Canada
| | - Evan Dimentberg
- Division of Pediatric Neurosurgery, Department of Surgery, Sainte Justine Hospital, University of Montreal, Montreal, Quebec, Canada
- Faculty of Medicine, Université Laval, Quebec City, Quebec, Canada
| | - Alain Bouthillier
- Division of Neurosurgery, University of Montreal Hospital Center, Montreal, Quebec, Canada
| | - Boris C Bernhardt
- McConnell Brain Imaging Center, Montreal Neurological Institute and Hospital, McGill University, Quebec, Canada
| | - Dang K Nguyen
- Division of Neurology, University of Montreal Medical Center, Montreal, Quebec, Canada
| | - Aria Fallah
- Department of Neurosurgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA
- Department of Pediatrics, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA
| | - Alexander G Weil
- Division of Pediatric Neurosurgery, Department of Surgery, Sainte Justine Hospital, University of Montreal, Montreal, Quebec, Canada
- Division of Neurosurgery, University of Montreal Hospital Center, Montreal, Quebec, Canada
- Brain and Child Development Axis, Sainte Justine Research Center, Montreal, Quebec, Canada
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16
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Hamdi H, Boissonneau S, Valton L, McGonigal A, Bartolomei F, Regis J. Radiosurgical Corpus Callosotomy for Intractable Epilepsy: Retrospective Long-Term Safety and Efficacy Assessment in 19 Patients an Review of the Literature. Neurosurgery 2023; 93:156-167. [PMID: 36861968 DOI: 10.1227/neu.0000000000002394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 12/06/2022] [Indexed: 03/03/2023] Open
Abstract
BACKGROUND Some patients suffering from intractable epileptic seizures, particularly drop attacks (DAs), are nonremediable by curative techniques. Palliative procedure carries a significant rate of surgical and neurological complications. OBJECTIVE To propose evaluation of safety and efficacy of Gamma Knife corpus callosotomy (GK-CC) as an alternative to microsurgical corpus callosotomy. METHODS This study included retrospective analysis of 19 patients who underwent GK-CC between 2005 and 2017. RESULTS Of the 19 patients, 13 (68%) had improvement in seizure control and 6 had no significant improvement. Of the 13/19 (68%) with improvement in seizures, 3 (16%) became completely seizure-free, 2 (11%) became free of DA and generalized tonic-clonic but with residual other seizures, 3 (16%) became free of DA only, and 5 (26%) had >50% reduction in frequency of all seizure types. In the 6 (31%) patients with no appreciable improvement, there were residual untreated commissural fibers and incomplete callosotomy rather than failure of Gamma Knife to disconnect. Seven patients showed a transient mild complication (37% of patients, 33% of the procedures). No permanent complication or neurological consequence was observed during the clinical and radiological workup with a mean of 89 (42-181) months, except 1 patient who had no improvement of epilepsy and then aggravation of the pre-existing cognitive and walking difficulties (Lennox-Gastaut). The median time of improvement after GK-CC was 3 (1-6) months. CONCLUSION Gamma Knife callosotomy is safe and accurate with comparable efficacy to open callosotomy in this cohort of patients with intractable epilepsy suffering from severe drop attacks.
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Affiliation(s)
- Hussein Hamdi
- Department of Functional Neurosurgery and Gamma Knife Radiosurgery, Timone University Hospital, Aix-Marseille University, APHM, CHU Timone, Marseille, France
- Aix Marseille Univ, INSERM, INS, Inst Neurosci Syst, Marseille, France
- Functional and Stereotactic Unit, Neurological Surgery Department, Tanta University, Egypt
| | - Sébastien Boissonneau
- Department of Neurosurgery Aix-Marseille University, APHM, CHU Timone, Marseille, France
- Aix Marseille Univ, INSERM, INS, Inst Neurosci Syst, Marseille, France
| | - Luc Valton
- Department of Neurology, Hôpital PP Riquet-Purpan, Toulouse University Hospital, University of Toulouse, Toulouse, France
- Centre de Recherche Cerveau et Cognition (CerCo), UMR 5549, CNRS, Toulouse Mind and Brain Institute (TMBI), University of Toulouse, University Paul Sabatier, Toulouse, France
| | - Aileen McGonigal
- Department of Clinical Neurophysiology, APHM, APHM, CHU Timone, Marseille, France
- Aix Marseille Univ, INSERM, INS, Inst Neurosci Syst, Marseille, France
- Department of Neurosciences, Mater Hospital, Brisbane and Faculty of Medicine, University of Queensland, Australia
| | - Fabrice Bartolomei
- Department of Clinical Neurophysiology, APHM, APHM, CHU Timone, Marseille, France
- Aix Marseille Univ, INSERM, INS, Inst Neurosci Syst, Marseille, France
| | - Jean Regis
- Department of Functional Neurosurgery and Gamma Knife Radiosurgery, Timone University Hospital, Aix-Marseille University, APHM, CHU Timone, Marseille, France
- Aix Marseille Univ, INSERM, INS, Inst Neurosci Syst, Marseille, France
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17
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Lu D, Wang T, Yang Y, Fan X, Chen S, Wei P, Shan Y, Zhao G. Advances in hypothalamic hamartoma research over the past 30 years (1992-2021): a bibliometric analysis. Front Neurol 2023; 14:1176459. [PMID: 37416311 PMCID: PMC10322195 DOI: 10.3389/fneur.2023.1176459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 05/16/2023] [Indexed: 07/08/2023] Open
Abstract
Background Hypothalamic hamartoma (HH) is a rare intracranial disease whose manifestations include gelastic seizures and precocious puberty. The diagnosis and treatment of HH have changed substantially over the past three decades as medical care has improved. Bibliometrics can reveal the evolution and development of a scientific field. Methods Documents on HH were retrieved from the Web of Science Core Collection (WoSCC) database on September 8, 2022. The search terms were as follows: "hypothalamic hamartoma" or "hamartoma of the hypothalamus" or "hypothalamic hamartomas." The types of documents were restricted to articles, case reports, and reviews. VOSviewer, CiteSpace, and the R package "bibliometrix" were used for a bibliometric analysis. Results A total of 667 independent documents on HH were obtained from the WoSCC database. The most common types of documents were articles (n = 498, 75%) and reviews (n = 103, 15%). The number of annual publications fluctuated but showed an upward trend overall, and the annual growth rate was 6.85%. The cumulative publication data indicated that the most influential journals in the HH field include Epilepsia, Epileptic Disorders, Child's Nervous System, Neurosurgery, and the Journal of Neurosurgery. Kerrigan JF, Ng YT, Rekate HL, Regis J, and Kameyama S were among the most prominent authors in the field of HH, with numerous publications and citations. American research institutions, especially the Barrow Neurological Institute, occupied a pivotal position in HH research. Other countries and institutions were catching up and producing considerable research results. Research on HH has steadily switched its emphasis from Pallister-Hall syndrome (PHS) and precocious puberty to epilepsy and new diagnostic and therapeutic techniques, including Gamma Knife, laser ablation, and interstitial thermal therapy. Conclusion HH remains a special neurological disease with significant research prospects. The development of novel technologies, including MRI-guided laser-induced thermal therapy (MRg-LiTT) and stereotactic radiofrequency thermocoagulation (RF-TC), has enabled the efficient treatment of gelastic seizures in HH while minimizing the risks associated with craniotomies. Through bibliometric analysis, this study points out the direction for future HH research.
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Affiliation(s)
- Di Lu
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- Clinical Research Center for Epilepsy, Capital Medical University, Beijing, China
| | - Tianren Wang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- Clinical Research Center for Epilepsy, Capital Medical University, Beijing, China
| | - Yanfeng Yang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- Clinical Research Center for Epilepsy, Capital Medical University, Beijing, China
| | - Xiaotong Fan
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- Clinical Research Center for Epilepsy, Capital Medical University, Beijing, China
| | - Sichang Chen
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- Clinical Research Center for Epilepsy, Capital Medical University, Beijing, China
| | - Penghu Wei
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- Clinical Research Center for Epilepsy, Capital Medical University, Beijing, China
- Beijing Municipal Geriatric Medical Research Center, Beijing, China
| | - Yongzhi Shan
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- Clinical Research Center for Epilepsy, Capital Medical University, Beijing, China
| | - Guoguang Zhao
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- Clinical Research Center for Epilepsy, Capital Medical University, Beijing, China
- Beijing Municipal Geriatric Medical Research Center, Beijing, China
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18
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Wei Z, Vodovotz L, Luy DD, Deng H, Niranjan A, Lunsford LD. Stereotactic radiosurgery as the initial management option for small-volume hypothalamic hamartomas with intractable epilepsy: a 35-year institutional experience and systematic review. J Neurosurg Pediatr 2023; 31:52-60. [PMID: 36272114 DOI: 10.3171/2022.9.peds22200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Accepted: 09/08/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Young patients with hypothalamic hamartomas (HHs) often present with intractable epilepsy. Currently there are no established management guidelines for HH. The authors retrospectively reviewed their single-institution experience to delineate the role of stereotactic radiosurgery (SRS). METHODS Seven patients with HHs (4 females; median age 13.7 years, range 2.5-25 years) with no prior resection underwent SRS between 1987 and 2022. The clinical history, epilepsy profile, radiographic findings, and neurological outcomes were characterized. HH topographical types were classified according to the Régis classification. Outcome measures included Engel seizure classification, HH response, and the need for additional surgical interventions. RESULTS All patients had Engel class IV epilepsy. A Leksell Gamma Knife was used to deliver a median margin dose of 18 Gy (range 16-20 Gy) to a median hamartoma volume of 0.37 cm3 (range 0.20-0.89 cm3). Seizure reduction was confirmed in 6 patients, and 2 patients had regression of their hamartoma. Two patients underwent resection and/or laser interstitial thermal therapy after SRS. At follow-up, 1 patient was seizure free, 4 patients achieved Engel class II, 1 patient had Engel class III, and 1 patient had Engel class IV seizure outcomes. CONCLUSIONS SRS as the initial management option for HH was associated with a low risk of adverse effects. In this institutional series reviewing small-volume HHs treated with SRS, no adverse radiation effect was detected, and the majority of patients experienced seizure reduction. SRS should be considered as the first-line treatment for seizure control in patients with small-volume HHs.
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Affiliation(s)
- Zhishuo Wei
- 1School of Medicine, University of Pittsburgh Medical Center
- 2Center for Image-Guided Neurosurgery, University of Pittsburgh Medical Center; and
| | - Lena Vodovotz
- 1School of Medicine, University of Pittsburgh Medical Center
- 2Center for Image-Guided Neurosurgery, University of Pittsburgh Medical Center; and
| | - Diego D Luy
- 1School of Medicine, University of Pittsburgh Medical Center
- 2Center for Image-Guided Neurosurgery, University of Pittsburgh Medical Center; and
| | - Hansen Deng
- 2Center for Image-Guided Neurosurgery, University of Pittsburgh Medical Center; and
- 4Radiation Oncology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Ajay Niranjan
- 2Center for Image-Guided Neurosurgery, University of Pittsburgh Medical Center; and
- 4Radiation Oncology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - L Dade Lunsford
- 2Center for Image-Guided Neurosurgery, University of Pittsburgh Medical Center; and
- 4Radiation Oncology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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19
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Yao Y, Wang X, Hu W, Zhang C, Sang L, Zheng Z, Mo J, Liu C, Qiu J, Shao X, Zhang J, Zhang K. Magnetic Resonance-Guided Laser Interstitial Thermal Therapy for Hypothalamic Hamartoma: Surgical Approach and Treatment Outcomes. J Clin Med 2022; 11:6579. [PMID: 36362807 PMCID: PMC9658093 DOI: 10.3390/jcm11216579] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 10/31/2022] [Accepted: 11/04/2022] [Indexed: 09/18/2023] Open
Abstract
Hypothalamic hamartoma (HH) is a rare lesion consisting of normal neurons and neuroglia arranged in an abnormal pattern which usually causes gelastic seizures (GS). Magnetic resonance-guided laser interstitial thermal therapy (MRgLITT) has been developed as a minimally invasive approach to treat HH and gradually become a first-line treatment. In total, this study enrolled 47 consecutive HH patients that underwent one round of ablation. Patients were followed for at least one year. Patients' medical records and surgical information were carefully reviewed, and univariate analyses were performed. Of the treated patients, 72.3% remained GS-free in this study, with an overall Engel class I rate of 68.1%. Long-term postoperative complications occurred in six patients. Factors associated with GS prognosis included Delalande classification (p = 0.033), HH volume (p = 0.01), and the ablation rate of the HH body (p = 0.035). The disconnection rate was 0.73 ± 0.14 in the Engel class Ia group as compared to 0.62 ± 0.13 in the Engel Ib-Engel IV group (p = 0.046). MRgLITT represents a safe and effective surgical procedure. Patients with larger or Delalande type IV HH may require multiple rounds of ablation. In addition to assessing the degree of disconnection, ablation volume should also be carefully considered for patients undergoing this procedure.
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Affiliation(s)
- Yuan Yao
- Department of Neurosurgery, Beijing TianTan Hospital, Capital Medical University, Beijing 100070, China
| | - Xiu Wang
- Department of Neurosurgery, Beijing TianTan Hospital, Capital Medical University, Beijing 100070, China
| | - Wenhan Hu
- Beijing Neurosurgical Institute, Capital Medical University, Beijing 100070, China
| | - Chao Zhang
- Department of Neurosurgery, Beijing TianTan Hospital, Capital Medical University, Beijing 100070, China
| | - Lin Sang
- Department of Neurosurgery, Beijing FengTai Hospital, Beijing 100070, China
| | - Zhong Zheng
- Department of Neurosurgery, Beijing FengTai Hospital, Beijing 100070, China
| | - Jiajie Mo
- Department of Neurosurgery, Beijing TianTan Hospital, Capital Medical University, Beijing 100070, China
| | - Chang Liu
- Department of Neurosurgery, Beijing TianTan Hospital, Capital Medical University, Beijing 100070, China
| | - Jiaji Qiu
- Department of Neurosurgery, Beijing TianTan Hospital, Capital Medical University, Beijing 100070, China
| | - Xiaoqiu Shao
- Department of Neurosurgery, Beijing TianTan Hospital, Capital Medical University, Beijing 100070, China
| | - Jianguo Zhang
- Department of Neurosurgery, Beijing TianTan Hospital, Capital Medical University, Beijing 100070, China
| | - Kai Zhang
- Department of Neurosurgery, Beijing TianTan Hospital, Capital Medical University, Beijing 100070, China
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20
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Iranmehr A, Dabbagh Ohadi MA, Chavoshi M, Jahanbakhshi A, Slavin KV. Minimally invasive procedures for hypothalamic hamartoma–related epilepsy: a systematic review and meta-analysis. Neurosurg Focus 2022; 53:E8. [DOI: 10.3171/2022.7.focus22296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 07/25/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVE
Hypothalamic hamartoma (HH) is a rare, nonmalignant, heterotopic developmental malformation that consists of a mixture of normal neurons and glial cells. Resection of HHs has been associated with high rates of mortality and morbidity. Therefore, minimally invasive ablation methods could be the best treatment option for HH. The most frequently used minimally invasive options for HH ablation are radiofrequency thermocoagulation (RFT), laser ablation (LA), and stereotactic radiosurgery.
METHODS
To investigate three minimally invasive procedures in the treatment of refractory seizures related to HH, the authors conducted a systematic search in March 2022 in the MEDLINE, Embase, Scopus, and Web of Science databases in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Seizure freedom was the primary outcome of interest. The authors defined seizure freedom as Engel class I or International League Against Epilepsy class 1 or 2 or as the reported term “seizure freedom.” The secondary outcome was long-term complications reported in studies. Both random- and fixed-effects models were used to calculate the pooled proportion of seizure freedom and complication rate with 95% confidence intervals. A modified version of the Joanna Briggs Institute (JBI) Critical Appraisal to assess the risk of bias was used.
RESULTS
The authors included 15 studies with 422 patients (RFT, n = 190; LA, n = 171; and Gamma Knife Radiosurgery [GKRS], n = 61). Generally, the mean incidences of overall seizure freedom after minimally invasive procedures were 77% (95% CI 0.74–0.81) and 68% (95% CI 0.57–0.79) using fixed- and random-effects models, respectively. The mean incidence of overall seizure freedom after RFT was 69% (95% CI 0.63–0.75), and the mean incidences of overall seizure freedom after LA and GKRS were 87% (95% CI 0.82–0.92) and 44% (95% CI 0.32–0.57), respectively. The total complication rate with minimally invasive procedures was 13% (95% CI 0.01–0.26). The complication rate in each treatment was as follows: 5% (95% CI 0.0–0.12) for RFT, 20% (95% CI 0.0–0.47) for LA, and 22% (95% CI 0–0.65) for GKRS. Meta-regression analysis showed an association between older age and higher complication rates in the LA group.
CONCLUSIONS
In this meta-analysis, LA showed superiority in seizure freedom over the other two methods. The complication rate associated with RFT was less than those in the other two methods; however, this difference was not statistically significant.
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Affiliation(s)
- Arad Iranmehr
- Neurosurgery Department, Imam Khomeini Hospital Complex (IKHC), Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Amin Dabbagh Ohadi
- Neurosurgery Department, Imam Khomeini Hospital Complex (IKHC), Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammadreza Chavoshi
- Department of Radiology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Amin Jahanbakhshi
- Stem Cell and Regenerative Medicine Research Center, Iran University of Medical Sciences, Tehran, Iran; and
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21
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Tierney TS, Alavian KN, Altman N, Bhatia S, Duchowny M, Hyslop A, Jayakar P, Resnick T, Wang S, Miller I, Ragheb J. Initial experience with magnetic resonance-guided focused ultrasound stereotactic surgery for central brain lesions in young adults. J Neurosurg 2022; 137:760-767. [PMID: 35171812 DOI: 10.3171/2021.10.jns21416] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 10/12/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Magnetic resonance-guided focused ultrasound (MRgFUS) is an incisionless procedure capable of thermoablation through the focus of multiple acoustic beams. Although MRgFUS is currently approved for the treatment of tremor in adults, its safety and feasibility profile for intracranial lesions in the pediatric and young adult population remains unknown. METHODS The long-term outcomes of a prospective single-center, single-arm trial of MRgFUS at Nicklaus Children's Hospital in Miami, Florida, are presented. Patients 15-22 years of age with centrally located lesions were recruited, clinically consistent with WHO grade I tumors that require surgical intervention. This cohort consisted of 4 patients with hypothalamic hamartoma (HH), and 1 patient with tuberous sclerosis complex harboring a subependymal giant cell astrocytoma (SEGA). RESULTS In each case, high-intensity FUS was used to target the intracranial lesion. Real-time MRI was used to monitor the thermoablations. Primary outcomes of interest were tolerability, feasibility, and safety of FUS. The radiographic ablation volume on intra- and postoperative MRI was also assessed. All 5 patients tolerated the procedure without any complications. Successful thermoablation was achieved in 4 of the 5 cases; the calcified SEGA was undertreated due to intratumor calcification, which prevented attainment of the target ablation temperature. The HHs underwent target tissue thermoablations that led to MR signal changes at the treatment site. For the patients harboring HHs, FUS thermoablations occurred without procedure-related complications and led to improvement in seizure control or hypothalamic hyperphagia. All 5 patients were discharged home on postoperative day 1 or 2, without any readmissions. There were no cases of hemorrhage, electrolyte derangement, endocrinopathy, or new neurological deficit in this cohort. CONCLUSIONS This experience demonstrates that FUS thermoablation of centrally located brain lesions in adolescents and young adults can be performed safely and that it provides therapeutic benefit for associated symptoms.
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Affiliation(s)
- Travis S Tierney
- 1Department of Brain Sciences, Imperial College London, London, United Kingdom
| | - Kambiz N Alavian
- 1Department of Brain Sciences, Imperial College London, London, United Kingdom
| | - Nolan Altman
- 2Department of Radiology
- Departments of3Radiology
- Departments of4Radiology
| | - Sanjiv Bhatia
- 5Division of Neurosurgery, Brain Institute, and
- 6Neurosurgery, and
| | - Michael Duchowny
- 7Division of Neurology, Brain Institute, Nicklaus Children's Hospital
- 8Neurology, University of Miami Miller School of Medicine; and
- 9Neurology
| | - Ann Hyslop
- 7Division of Neurology, Brain Institute, Nicklaus Children's Hospital
- 10Pediatrics, and
| | - Prasanna Jayakar
- 7Division of Neurology, Brain Institute, Nicklaus Children's Hospital
- 11Neurosciences and Biomedical Engineering, Florida International University, Miami, Florida
| | - Trevor Resnick
- 7Division of Neurology, Brain Institute, Nicklaus Children's Hospital
- 8Neurology, University of Miami Miller School of Medicine; and
- 9Neurology
| | - Shelly Wang
- 5Division of Neurosurgery, Brain Institute, and
- 6Neurosurgery, and
| | - Ian Miller
- 7Division of Neurology, Brain Institute, Nicklaus Children's Hospital
| | - John Ragheb
- 5Division of Neurosurgery, Brain Institute, and
- 6Neurosurgery, and
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22
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Romanelli P, Tuniz F, Fabbro S, Beltramo G, Conti A. Image-guided LINAC radiosurgery in hypothalamic hamartomas. Front Neurol 2022; 13:909829. [PMID: 36119668 PMCID: PMC9475216 DOI: 10.3389/fneur.2022.909829] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 08/01/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction Hypothalamic hamartomas (HH) are developmental malformations that are associated with mild to severe drug-refractory epilepsy. Stereotactic radiosurgery (SRS) is an emerging non-invasive option for the treatment of small and medium-sized HH, providing good seizure outcomes without neurological complications. Here, we report our experience treating HH with frameless LINAC SRS. Materials and methods We retrospectively collected clinical and neuroradiological data of ten subjects with HH-related epilepsy that underwent frameless image-guided SRS. Results All patients underwent single-fraction SRS using a mean prescribed dose of 16.27 Gy (range 16–18 Gy). The median prescription isodose was 79% (range 65–81 Gy). The mean target volume was 0.64 cc (range 0.26–1.16 cc). Eight patients experienced complete or near complete seizure freedom (Engel class I and II). Five patients achieved complete seizure control within 4 to 18 months after the treatment. Four patients achieved Engel class II outcome, with stable results. One patient had a reduction of seizure burden superior to 50% (Engel class III). One patient had no benefit at all (Engel class IV) and refused further treatments. Overall, at the last follow-up, three patients experience class I, five class II, one class III and one class IV outcome. No neurological complications were reported. Conclusions Frameless LINAC SRS provides good seizure and long-term neuropsychosocial outcome, without the risks of neurological complications inherently associated with microsurgical resection.
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Affiliation(s)
- Pantaleo Romanelli
- Cyberknife Center, Italian Diagnostic Center (CDI), Milan, Italy
- *Correspondence: Pantaleo Romanelli
| | - Francesco Tuniz
- Department of Neurosurgery, ASUFC “Santa Maria della Misericordia”, Udine, Italy
| | - Sara Fabbro
- Department of Neurosurgery, ASUFC “Santa Maria della Misericordia”, Udine, Italy
| | | | - Alfredo Conti
- Dipartimento di Scienze Biomediche e Neuromotorie (DIBINEM), IRCCS Istituto delle Scienze Neurologiche di Bologna, Alma Mater Studiorum-Università di Bologna, Bologna, Italy
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23
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Handoko M, Karakas C, Gadgil N, Wilfong A, Riviello J, Curry D, Ali I. Comparison of Surgical Outcomes in Individuals With Hypothalamic Hamartoma Alone or With Other Potentially Epileptogenic Focal Lesions. Pediatr Neurol 2022; 131:13-19. [PMID: 35461053 DOI: 10.1016/j.pediatrneurol.2022.03.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 02/02/2022] [Accepted: 03/26/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Hypothalamic hamartoma is a rare condition associated with refractory seizures. It can occur in isolation or with additional epileptogenic lesions. The aim of this study was to investigate the effects of additional potentially epileptogenic lesions on surgical outcomes in individuals with hypothalamic hamartoma. METHODS We conducted a chart review of 112 patients with hypothalamic hamartoma who underwent magnetic resonance imaging (MRI)-guided laser interstitial thermal therapy targeted to the hypothalamic hamartoma. We compared surgical outcomes after at least six months of postoperative follow-up (N = 65) between patients with hypothalamic hamartoma alone and those with hypothalamic hamartoma plus additional potentially epileptogenic lesions. RESULTS Sixteen out of 112 (14%) patients had additional epileptogenic lesions, including focal cortical dysplasia, gray matter heterotopia, and polymicrogyria. Ten out of 16 patients with additional lesions and 55 out of 96 patients with hypothalamic hamartoma alone had more than six months of follow-up and are included in the outcome analysis. Mean follow-up in these patients is 21.5 ± 17.3 months (standard deviation, range: 7.3-76.8 months) for patients with hypothalamic hamartoma alone and 16.1 ± 15.0 months (standard deviation, range: 6.6-58.2 months) for those with hypothalamic hamartoma plus additional epileptogenic lesions. Fewer patients with hypothalamic hamartoma plus other lesions had Engel class I/II outcomes than patients with hypothalamic hamartoma alone (5/10 [50%] vs 46/55 [83.6%]; P = 0.031). CONCLUSIONS MRI-guided laser interstitial thermal therapy remains an effective treatment option for patients with hypothalamic hamartoma. However, the outcome of surgical procedures targeted to the hypothalamic hamartoma may be less favorable in patients who have hypothalamic hamartoma coexisting with other potentially epileptogenic focal lesions. Thus, an additional surgical workup is warranted for these patients who have failed surgical treatment of hypothalamic hamartoma.
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Affiliation(s)
- Maureen Handoko
- Department of Neurology and Developmental Neuroscience, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Cemal Karakas
- Norton Children's Medical Group, The University of Louisville, Louisville, Kentucky
| | - Nisha Gadgil
- Division of Pediatric Neurosurgery, Department of Neurosurgery, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Angus Wilfong
- Department Pediatric Neurology, Phoenix Children's Hospital, University of Arizona, Phoenix, Arizona
| | - James Riviello
- Department of Neurology and Developmental Neuroscience, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Daniel Curry
- Norton Children's Medical Group, The University of Louisville, Louisville, Kentucky
| | - Irfan Ali
- Department of Neurology and Developmental Neuroscience, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas.
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24
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Tuleasca C, Hamdi H, Daquin G, Villeneuve N, Chauvel P, Lepine A, Bartolomei F, Régis J. Increased Gray Matter Density in the Right Mesencephalic Tegmentum Is Associated With Better Engel Classes I and II After Radiosurgery for Hypothalamic Hamartomas. Neurosurgery 2022; 90:180-185. [PMID: 34995238 DOI: 10.1227/neu.0000000000001738] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 08/21/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Hypothalamic hamartomas (HHs) are disabling congenital lesions, responsible for gelastic seizures frequently associated with catastrophic epilepsies, epileptogenic encephalopathy, and cognitive and psychiatric severe comorbidities. Stereotactic radiosurgery (SRS) is a well-established minimally invasive therapeutic approach. OBJECTIVE To assess whether pretherapeutic gray matter density (GMD) correlates with seizure outcome. METHODS We used voxel-based morphometry at whole-brain level, as depicted on pretherapeutic standard structural magnetic resonance neuroimaging. We examined 24 patients (10 male patients, 14 female patients; mean age, 12.7 yr; median, 9; range, 5.9-50) treated in Marseille University Hospital, France, between May 2001 and August 2018. RESULTS Most relevant anatomic area predicting postoperative Engel classes I and II vs III and IV after SRS for HHs was mesencephalic tegmentum. Higher pretherapeutic GMD in this area was associated with better outcomes for seizure cessation. The only other statistically significant clusters were right cerebellar lobule VIIIb and VIIIa. Lower pretherapeutic GMD in both clusters correlated with better Engel class outcomes. GMD decreased with age in the left mediodorsal thalamus. CONCLUSION Seizure cessation after SRS for HHs was associated with higher GMD in mesencephalic tegmental area, acknowledged to be involved in the neural control of explosive vocal behavior in animals. This area is connected by the mamillotegmental bundle to the lateral tuberal nucleus area of the hypothalamus, where HHs are known to rise. In the future, the detection of more gray matter in this "laugh" tegmental area based on pretherapeutic routine structural neuroimaging might help in patient selection for minimally invasive radiosurgery for HH.
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Affiliation(s)
- Constantin Tuleasca
- Neurosurgery Service and Gamma Knife Center, Lausanne University Hospital (CHUV), Lausanne, Switzerland
- Faculty of Biology and Medicine (FBM), University of Lausanne (Unil), Lausanne, Switzerland
- Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - Hussein Hamdi
- Aix-Marseille University, INSERM, UMR 1106, Marseille, France
- Functional and Stereotactic Neurosurgery and Gamma Knife Unit, Timone University Hospital, Marseille, France
- Functional Neurosurgery and Stereotaxy Unit, Neurological Surgery Department, Tanta University, Tanta, Egypt
| | - Géraldine Daquin
- Aix-Marseille University, INSERM, UMR 1106, Marseille, France
- Clinical Physiology Department, Timone University Hospital, Marseille, France
| | - Nathalie Villeneuve
- Clinical Physiology Department, Timone University Hospital, Marseille, France
| | - Patrick Chauvel
- Aix-Marseille University, INSERM, UMR 1106, Marseille, France
- Clinical Physiology Department, Timone University Hospital, Marseille, France
| | - Anne Lepine
- Clinical Physiology Department, Timone University Hospital, Marseille, France
| | - Fabrice Bartolomei
- Aix-Marseille University, INSERM, UMR 1106, Marseille, France
- Clinical Physiology Department, Timone University Hospital, Marseille, France
| | - Jean Régis
- Aix-Marseille University, INSERM, UMR 1106, Marseille, France
- Functional and Stereotactic Neurosurgery and Gamma Knife Unit, Timone University Hospital, Marseille, France
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25
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Ganz JC. Epilepsy. PROGRESS IN BRAIN RESEARCH 2022; 268:329-345. [PMID: 35074089 DOI: 10.1016/bs.pbr.2021.10.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
GKNS has been introduced as an alternative to microsurgery for the treatment of certain types of focal epilepsy. It was first noted that epilepsy associated with AVMs often improved before the obliteration of the vascular lesion. It was subsequently shown that the treatment could be effective in mesial temporal lobe epilepsy (MTLE) producing remission in around 60% of patients, provided the treatment was carried out as originally designed. GKNS has also been useful in the treatment of gelastic epilepsy associated with hypothalamic hamartomas.
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Affiliation(s)
- Jeremy C Ganz
- Department of Neurosurgery, Haukeland University Hospital, Bergen, Norway.
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26
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Lehner KR, D'Amico RS, Rahme R, Schneider JR, Privler GG, Faltings LJ, Du VX, Boockvar JA, Rekate HL, Langer DJ. Microsurgical management of complex hypothalamic hamartomas in the era of minimally invasive therapy: a case series and narrative review. World Neurosurg 2022; 160:e388-e397. [PMID: 35032713 DOI: 10.1016/j.wneu.2022.01.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 01/06/2022] [Accepted: 01/07/2022] [Indexed: 10/19/2022]
Abstract
INTRODUCTION There has been a paradigm shift in the management of hypothalamic hamartoma (HH) from traditional microsurgical techniques to less invasive alternatives. However, large and extensive HH may fail to respond to these therapies, ultimately necessitating craniotomies. METHODS All patients who underwent microsurgical resection of a complex HH by the 2 senior authors from 2011-2021 were included. Charts were retrospectively reviewed and demographic, clinical, imaging, and outcome data were recorded. RESULTS 8 patients (mean age 7 years) were included. 2 had failed previous treatments. All 7 presented with gelastic seizures and cognitive dysfunction, 6 exhibited central precocious puberty, and 3 had behavioral problems. Mean lesion size was 21.6 mm and all had interpeduncular extension, 5 had intraventricular extension (Delalande type I: 3, type III: 4, type IV: 1). A frontotemporal orbitozygomatic (FTOZ) approach with optic nerve decompression was used in all patients, supplemented by another approach in 3 (endoscopic transventricular: 3, transcallosal: 1). Gross total resection was achieved in 6 patients and subtotal resection in 2. Transient complications occurred in 3 patients (37.5%): self-limited sodium imbalance (n=3), subdural hygroma (n=2). Permanent complications occurred in 2 patients (25%): perforator infarct (n=1), short-term memory loss (n=1). All patients experienced seizure resolution with preserved hypothalamic-pituitary axis function. After a mean follow-up of 41 months (2-66), 7 patients remain seizure-free, while 1 has rare seizures. Cognitive and behavioral symptoms improved in all patients. CONCLUSION For large HH with interpeduncular extension, microsurgery via the FTOZ approach is a safe and highly effective treatment modality.
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Affiliation(s)
- Kurt R Lehner
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Randy S D'Amico
- Department of Neurosurgery, Lenox Hill Hospital, Hofstra/Northwell School of Medicine, New York, NY, USA; Department of Neurosurgery, Wyckoff Heights Medical Center, Brooklyn, NY, USA
| | - Ralph Rahme
- Department of Neurosurgery, Lenox Hill Hospital, Hofstra/Northwell School of Medicine, New York, NY, USA
| | - Julia R Schneider
- Department of Neurosurgery, Lenox Hill Hospital, Hofstra/Northwell School of Medicine, New York, NY, USA
| | - Gloria G Privler
- Department of Neurosurgery, Lenox Hill Hospital, Hofstra/Northwell School of Medicine, New York, NY, USA
| | - Lukas J Faltings
- Department of Neurosurgery, Lenox Hill Hospital, Hofstra/Northwell School of Medicine, New York, NY, USA
| | - Victor X Du
- Department of Neurosurgery, North Shore University Hospital, Hofstra/Northwell School of Medicine, Manhasset, NY, USA
| | - John A Boockvar
- Department of Neurosurgery, Lenox Hill Hospital, Hofstra/Northwell School of Medicine, New York, NY, USA; Department of Neurosurgery, North Shore University Hospital, Hofstra/Northwell School of Medicine, Manhasset, NY, USA; Department of Neurosurgery, Long Island Jewish/Cohen Children's Medical Center, Hofstra/Northwell School of Medicine, Queens, NY, USA
| | - Harold L Rekate
- Department of Neurosurgery, Lenox Hill Hospital, Hofstra/Northwell School of Medicine, New York, NY, USA; Department of Neurosurgery, North Shore University Hospital, Hofstra/Northwell School of Medicine, Manhasset, NY, USA; Department of Neurosurgery, Long Island Jewish/Cohen Children's Medical Center, Hofstra/Northwell School of Medicine, Queens, NY, USA
| | - David J Langer
- Department of Neurosurgery, Lenox Hill Hospital, Hofstra/Northwell School of Medicine, New York, NY, USA; Department of Neurosurgery, North Shore University Hospital, Hofstra/Northwell School of Medicine, Manhasset, NY, USA; Department of Neurosurgery, Long Island Jewish/Cohen Children's Medical Center, Hofstra/Northwell School of Medicine, Queens, NY, USA.
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27
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Savateev AN, Golanov AV, Saushev DA, Osinov IK, Kostyuchenko VV, Dalechina AV, Melikian AG, Vlasov PA, Mazerkina NA, Makashova ES. [Stereotactic radiosurgery for epilepsy related to hypothalamic hamartoma]. ZHURNAL VOPROSY NEIROKHIRURGII IMENI N. N. BURDENKO 2022; 86:14-24. [PMID: 35942833 DOI: 10.17116/neiro20228604114] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
UNLABELLED Hypothalamic hamartoma (HH) is a dysplastic lesion fused with hypothalamus and followed by epilepsy, precocious puberty and behavioral disorders. Up to 50% of patients become free of seizures after surgery, but various complications occur in 1/4 of cases. Radiofrequency thermocoagulation, laser interstitial thermal therapy and stereotactic radiosurgery (SRS) are alternative treatment options. OBJECTIVE To define the indications for SRS in patients with HH and to clarify the irradiation parameters. MATERIAL AND METHODS Twenty-two patients with HH and epilepsy underwent SRS at the Moscow Gamma-knife Center. A retrospective analysis included 19 patients with sufficient follow-up data. Median age of patients was 11.5 years (range 1.3-25.8). The diameter of irradiated HHs ranged between 5.5 and 40.9 mm. In 8 (36%) cases, the volume of hamartoma exceeded 3 cm3. Mean prescribed dose was 18±2.0 Gy, mean prescribed isodose - 48±4.2%. Median follow-up period was 14.8 months (range 3.4 - 96.1). RESULTS Three (15.8%) patients were free of seizures. One patient (5.3%) improved dramatically after treatment with compete resolution of generalized seizures and experienced only rare emotional seizures (Engel IB). Eleven (57.8%) patients reported lower incidence of seizures. Severity and incidence of seizures were the same in 4 patients (21.1%). The best results were achieved in mean target dose over 20-22 Gy, minimal target dose over 7-10 Gy, covering by the prescribed dose of at least 70-80% of hamartoma volume, as well as in patients with the prescribed dose of 12 Gy delivered to almost entire volume of tumor. None patient had any complications after SRS. CONCLUSION SRS is safe regarding neurological, endocrine or visual disturbances. Careful patient selection for SRS makes it an effective option for HH-related epilepsy. The best candidates for SRS are children with seizures aged over 1 year, hamartoma <3 cm3 and area of fusion with hypothalamus <150 mm2.
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Affiliation(s)
| | - A V Golanov
- Burdenko Neurosurgical Center, Moscow, Russia
| | | | - I K Osinov
- Moscow Gamma-knife Center, Moscow, Russia
| | | | | | | | - P A Vlasov
- Burdenko Neurosurgical Center, Moscow, Russia
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Melikyan AG. [Surgical treatment of epilepsy in patients with hypothalamic hamartomas]. ZHURNAL VOPROSY NEIROKHIRURGII IMENI N. N. BURDENKO 2022; 86:83-88. [PMID: 35942841 DOI: 10.17116/neiro202286041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
UNLABELLED The purpose of this review was to analyze the current ideas about various techniques and methods for treating epilepsy in patients with hypothalamic hamartomas including microsurgery, endoscopy, radiofrequency thermal destruction, stereotactic laser ablation and radiosurgery. Data characterizing their effectiveness, limitations and complications are considered. CONCLUSION When choosing the optimal treatment option, it is necessary to take into account patient age and course of disease, anatomical and topographic features of hamartoma location, previous attempts of treatment, opinion of the patient and his guardians, as well as surgical experience.
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Consales A, Cognolato E, Pacetti M, Mancardi MM, Tortora D, Di Perna G, Piatelli G, Nobili L. Magnetic Resonance-Guided Laser Interstitial Thermal Therapy (MR-gLiTT) in Pediatric Epilepsy Surgery: State of the Art and Presentation of Giannina Gaslini Children's Hospital (Genoa, Italy) Series. Front Neurol 2021; 12:739034. [PMID: 34764929 PMCID: PMC8577648 DOI: 10.3389/fneur.2021.739034] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 09/27/2021] [Indexed: 11/13/2022] Open
Abstract
Magnetic resonance-guided laser interstitial thermal therapy (MR-gLiTT) is a novel minimally invasive treatment approach for drug-resistant focal epilepsy and brain tumors. Using thermal ablation induced by a laser diode implanted intracranially in a stereotactic manner, the technique is highly effective and safe, reducing the risk associated with more traditional open surgical approaches that could lead to increased neurological morbidity. Indications for MR-gLiTT in pediatric epilepsy surgery include hypothalamic hamartoma, tuberous sclerosis complex, cavernoma-related epilepsy, SEEG-guided seizure onset zone ablation, corpus callosotomy, periventricular nodular heterotopia, mesial temporal lobe epilepsy, and insular epilepsy. We review the available literature on the topic and present our series of patients with drug-resistant epilepsy treated by MR-gLiTT. Our experience, represented by six cases of hypothalamic hamartomas, one case of tuberous sclerosis, and one case of dysembryoplastic neuroepithelial tumor, helps to confirm that MR-gLiTT is a highly safe and effective procedure for several epilepsy conditions in children.
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Affiliation(s)
- Alessandro Consales
- Unit of Neurosurgery, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Giannina Gaslini, Genoa, Italy
| | - Erica Cognolato
- DINOGMI, University of Genoa, Genoa, Italy.,Unit of Child Neuropsychiatry, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Giannina Gaslini, Genoa, Italy
| | - Mattia Pacetti
- Unit of Neurosurgery, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Giannina Gaslini, Genoa, Italy.,DINOGMI, University of Genoa, Genoa, Italy
| | - Maria Margherita Mancardi
- Unit of Child Neuropsychiatry, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Giannina Gaslini, Genoa, Italy
| | - Domenico Tortora
- Unit of Neuroradiology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Giannina Gaslini, Genoa, Italy
| | - Giuseppe Di Perna
- Unit of Neurosurgery, Azienda Ospedaliera Universitaria (AOU) Città della Scienza e della Salute, University of Turin, Turin, Italy
| | - Gianluca Piatelli
- Unit of Neurosurgery, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Giannina Gaslini, Genoa, Italy
| | - Lino Nobili
- DINOGMI, University of Genoa, Genoa, Italy.,Unit of Child Neuropsychiatry, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Giannina Gaslini, Genoa, Italy
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Cohen NT, Cross JH, Arzimanoglou A, Berkovic SF, Kerrigan JF, Miller IP, Webster E, Soeby L, Cukiert A, Hesdorffer DK, Kroner BL, Saper CB, Schulze-Bonhage A, Gaillard WD. Hypothalamic Hamartomas: Evolving Understanding and Management. Neurology 2021; 97:864-873. [PMID: 34607926 PMCID: PMC8610628 DOI: 10.1212/wnl.0000000000012773] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 08/31/2021] [Indexed: 11/15/2022] Open
Abstract
Hypothalamic hamartomas (HH) are rare, basilar developmental lesions with widespread comorbidities often associated with refractory epilepsy and encephalopathy. Imaging advances allow for early, even prenatal, detection. Genetic studies suggest mutations in GLI3 and other patterning genes are involved in HH pathogenesis. About 50%-80% of children with HH have severe rage and aggression and a majority of patients exhibit externalizing disorders. Behavioral disruption and intellectual disability may predate epilepsy. Neuropsychological, sleep, and endocrine disorders are typical. The purpose of this article is to provide a summary of the current understanding of HH and to highlight opportunities for future research.
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Affiliation(s)
- Nathan T Cohen
- From the Center for Neuroscience Research (N.T.C., W.D.G.), Children's National Hospital, The George Washington University School of Medicine, Washington, DC; UCL NIHR BRC Great Ormond Street Institute of Child Health (J.H.C.), Member of ERN-EpiCARE, London; Great Ormond Street Hospital for Children (J.H.C.), NHS Trust, London; Young Epilepsy (J.H.C.), Lingfield, Surrey, UK; Department of Pediatric Clinical Epileptology (A.A.), Sleep Disorders and Functional Neurology, Member of ERN-EpiCARE; HFME (A.A.), Hospices Civils de Lyon, France; Epilepsy Research Unit (A.A.), Barcelona's Children Hospital San Juan de Dios, Member of the ERN EpiCARE, Spain; Epilepsy Research Centre (S.F.B.), University of Melbourne, Australia; Division of Pediatric Neurology (J.F.K.), Barrow Neurological Institute at Phoenix Children's Hospital; Hope for Hypothalamic Hamartomas (I.P.M., E.W., L.S.), Phoenix, AZ; Epilepsy Surgery Program (A.C.), Clinica de Epilepsia de Sao Paulo, Brazil; Department of Epidemiology (D.K.H.), Columbia University Medical Center, New York, NY; RTI International (B.L.K.), Rockville, MD; Department of Neurology (C.B.S.), Beth-Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; and Epilepsy Center (A.S.-B.), Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Germany.
| | - J Helen Cross
- From the Center for Neuroscience Research (N.T.C., W.D.G.), Children's National Hospital, The George Washington University School of Medicine, Washington, DC; UCL NIHR BRC Great Ormond Street Institute of Child Health (J.H.C.), Member of ERN-EpiCARE, London; Great Ormond Street Hospital for Children (J.H.C.), NHS Trust, London; Young Epilepsy (J.H.C.), Lingfield, Surrey, UK; Department of Pediatric Clinical Epileptology (A.A.), Sleep Disorders and Functional Neurology, Member of ERN-EpiCARE; HFME (A.A.), Hospices Civils de Lyon, France; Epilepsy Research Unit (A.A.), Barcelona's Children Hospital San Juan de Dios, Member of the ERN EpiCARE, Spain; Epilepsy Research Centre (S.F.B.), University of Melbourne, Australia; Division of Pediatric Neurology (J.F.K.), Barrow Neurological Institute at Phoenix Children's Hospital; Hope for Hypothalamic Hamartomas (I.P.M., E.W., L.S.), Phoenix, AZ; Epilepsy Surgery Program (A.C.), Clinica de Epilepsia de Sao Paulo, Brazil; Department of Epidemiology (D.K.H.), Columbia University Medical Center, New York, NY; RTI International (B.L.K.), Rockville, MD; Department of Neurology (C.B.S.), Beth-Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; and Epilepsy Center (A.S.-B.), Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Germany
| | - Alexis Arzimanoglou
- From the Center for Neuroscience Research (N.T.C., W.D.G.), Children's National Hospital, The George Washington University School of Medicine, Washington, DC; UCL NIHR BRC Great Ormond Street Institute of Child Health (J.H.C.), Member of ERN-EpiCARE, London; Great Ormond Street Hospital for Children (J.H.C.), NHS Trust, London; Young Epilepsy (J.H.C.), Lingfield, Surrey, UK; Department of Pediatric Clinical Epileptology (A.A.), Sleep Disorders and Functional Neurology, Member of ERN-EpiCARE; HFME (A.A.), Hospices Civils de Lyon, France; Epilepsy Research Unit (A.A.), Barcelona's Children Hospital San Juan de Dios, Member of the ERN EpiCARE, Spain; Epilepsy Research Centre (S.F.B.), University of Melbourne, Australia; Division of Pediatric Neurology (J.F.K.), Barrow Neurological Institute at Phoenix Children's Hospital; Hope for Hypothalamic Hamartomas (I.P.M., E.W., L.S.), Phoenix, AZ; Epilepsy Surgery Program (A.C.), Clinica de Epilepsia de Sao Paulo, Brazil; Department of Epidemiology (D.K.H.), Columbia University Medical Center, New York, NY; RTI International (B.L.K.), Rockville, MD; Department of Neurology (C.B.S.), Beth-Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; and Epilepsy Center (A.S.-B.), Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Germany
| | - Samuel F Berkovic
- From the Center for Neuroscience Research (N.T.C., W.D.G.), Children's National Hospital, The George Washington University School of Medicine, Washington, DC; UCL NIHR BRC Great Ormond Street Institute of Child Health (J.H.C.), Member of ERN-EpiCARE, London; Great Ormond Street Hospital for Children (J.H.C.), NHS Trust, London; Young Epilepsy (J.H.C.), Lingfield, Surrey, UK; Department of Pediatric Clinical Epileptology (A.A.), Sleep Disorders and Functional Neurology, Member of ERN-EpiCARE; HFME (A.A.), Hospices Civils de Lyon, France; Epilepsy Research Unit (A.A.), Barcelona's Children Hospital San Juan de Dios, Member of the ERN EpiCARE, Spain; Epilepsy Research Centre (S.F.B.), University of Melbourne, Australia; Division of Pediatric Neurology (J.F.K.), Barrow Neurological Institute at Phoenix Children's Hospital; Hope for Hypothalamic Hamartomas (I.P.M., E.W., L.S.), Phoenix, AZ; Epilepsy Surgery Program (A.C.), Clinica de Epilepsia de Sao Paulo, Brazil; Department of Epidemiology (D.K.H.), Columbia University Medical Center, New York, NY; RTI International (B.L.K.), Rockville, MD; Department of Neurology (C.B.S.), Beth-Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; and Epilepsy Center (A.S.-B.), Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Germany
| | - John F Kerrigan
- From the Center for Neuroscience Research (N.T.C., W.D.G.), Children's National Hospital, The George Washington University School of Medicine, Washington, DC; UCL NIHR BRC Great Ormond Street Institute of Child Health (J.H.C.), Member of ERN-EpiCARE, London; Great Ormond Street Hospital for Children (J.H.C.), NHS Trust, London; Young Epilepsy (J.H.C.), Lingfield, Surrey, UK; Department of Pediatric Clinical Epileptology (A.A.), Sleep Disorders and Functional Neurology, Member of ERN-EpiCARE; HFME (A.A.), Hospices Civils de Lyon, France; Epilepsy Research Unit (A.A.), Barcelona's Children Hospital San Juan de Dios, Member of the ERN EpiCARE, Spain; Epilepsy Research Centre (S.F.B.), University of Melbourne, Australia; Division of Pediatric Neurology (J.F.K.), Barrow Neurological Institute at Phoenix Children's Hospital; Hope for Hypothalamic Hamartomas (I.P.M., E.W., L.S.), Phoenix, AZ; Epilepsy Surgery Program (A.C.), Clinica de Epilepsia de Sao Paulo, Brazil; Department of Epidemiology (D.K.H.), Columbia University Medical Center, New York, NY; RTI International (B.L.K.), Rockville, MD; Department of Neurology (C.B.S.), Beth-Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; and Epilepsy Center (A.S.-B.), Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Germany
| | - Ilene Penn Miller
- From the Center for Neuroscience Research (N.T.C., W.D.G.), Children's National Hospital, The George Washington University School of Medicine, Washington, DC; UCL NIHR BRC Great Ormond Street Institute of Child Health (J.H.C.), Member of ERN-EpiCARE, London; Great Ormond Street Hospital for Children (J.H.C.), NHS Trust, London; Young Epilepsy (J.H.C.), Lingfield, Surrey, UK; Department of Pediatric Clinical Epileptology (A.A.), Sleep Disorders and Functional Neurology, Member of ERN-EpiCARE; HFME (A.A.), Hospices Civils de Lyon, France; Epilepsy Research Unit (A.A.), Barcelona's Children Hospital San Juan de Dios, Member of the ERN EpiCARE, Spain; Epilepsy Research Centre (S.F.B.), University of Melbourne, Australia; Division of Pediatric Neurology (J.F.K.), Barrow Neurological Institute at Phoenix Children's Hospital; Hope for Hypothalamic Hamartomas (I.P.M., E.W., L.S.), Phoenix, AZ; Epilepsy Surgery Program (A.C.), Clinica de Epilepsia de Sao Paulo, Brazil; Department of Epidemiology (D.K.H.), Columbia University Medical Center, New York, NY; RTI International (B.L.K.), Rockville, MD; Department of Neurology (C.B.S.), Beth-Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; and Epilepsy Center (A.S.-B.), Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Germany
| | - Erica Webster
- From the Center for Neuroscience Research (N.T.C., W.D.G.), Children's National Hospital, The George Washington University School of Medicine, Washington, DC; UCL NIHR BRC Great Ormond Street Institute of Child Health (J.H.C.), Member of ERN-EpiCARE, London; Great Ormond Street Hospital for Children (J.H.C.), NHS Trust, London; Young Epilepsy (J.H.C.), Lingfield, Surrey, UK; Department of Pediatric Clinical Epileptology (A.A.), Sleep Disorders and Functional Neurology, Member of ERN-EpiCARE; HFME (A.A.), Hospices Civils de Lyon, France; Epilepsy Research Unit (A.A.), Barcelona's Children Hospital San Juan de Dios, Member of the ERN EpiCARE, Spain; Epilepsy Research Centre (S.F.B.), University of Melbourne, Australia; Division of Pediatric Neurology (J.F.K.), Barrow Neurological Institute at Phoenix Children's Hospital; Hope for Hypothalamic Hamartomas (I.P.M., E.W., L.S.), Phoenix, AZ; Epilepsy Surgery Program (A.C.), Clinica de Epilepsia de Sao Paulo, Brazil; Department of Epidemiology (D.K.H.), Columbia University Medical Center, New York, NY; RTI International (B.L.K.), Rockville, MD; Department of Neurology (C.B.S.), Beth-Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; and Epilepsy Center (A.S.-B.), Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Germany
| | - Lisa Soeby
- From the Center for Neuroscience Research (N.T.C., W.D.G.), Children's National Hospital, The George Washington University School of Medicine, Washington, DC; UCL NIHR BRC Great Ormond Street Institute of Child Health (J.H.C.), Member of ERN-EpiCARE, London; Great Ormond Street Hospital for Children (J.H.C.), NHS Trust, London; Young Epilepsy (J.H.C.), Lingfield, Surrey, UK; Department of Pediatric Clinical Epileptology (A.A.), Sleep Disorders and Functional Neurology, Member of ERN-EpiCARE; HFME (A.A.), Hospices Civils de Lyon, France; Epilepsy Research Unit (A.A.), Barcelona's Children Hospital San Juan de Dios, Member of the ERN EpiCARE, Spain; Epilepsy Research Centre (S.F.B.), University of Melbourne, Australia; Division of Pediatric Neurology (J.F.K.), Barrow Neurological Institute at Phoenix Children's Hospital; Hope for Hypothalamic Hamartomas (I.P.M., E.W., L.S.), Phoenix, AZ; Epilepsy Surgery Program (A.C.), Clinica de Epilepsia de Sao Paulo, Brazil; Department of Epidemiology (D.K.H.), Columbia University Medical Center, New York, NY; RTI International (B.L.K.), Rockville, MD; Department of Neurology (C.B.S.), Beth-Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; and Epilepsy Center (A.S.-B.), Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Germany
| | - Arthur Cukiert
- From the Center for Neuroscience Research (N.T.C., W.D.G.), Children's National Hospital, The George Washington University School of Medicine, Washington, DC; UCL NIHR BRC Great Ormond Street Institute of Child Health (J.H.C.), Member of ERN-EpiCARE, London; Great Ormond Street Hospital for Children (J.H.C.), NHS Trust, London; Young Epilepsy (J.H.C.), Lingfield, Surrey, UK; Department of Pediatric Clinical Epileptology (A.A.), Sleep Disorders and Functional Neurology, Member of ERN-EpiCARE; HFME (A.A.), Hospices Civils de Lyon, France; Epilepsy Research Unit (A.A.), Barcelona's Children Hospital San Juan de Dios, Member of the ERN EpiCARE, Spain; Epilepsy Research Centre (S.F.B.), University of Melbourne, Australia; Division of Pediatric Neurology (J.F.K.), Barrow Neurological Institute at Phoenix Children's Hospital; Hope for Hypothalamic Hamartomas (I.P.M., E.W., L.S.), Phoenix, AZ; Epilepsy Surgery Program (A.C.), Clinica de Epilepsia de Sao Paulo, Brazil; Department of Epidemiology (D.K.H.), Columbia University Medical Center, New York, NY; RTI International (B.L.K.), Rockville, MD; Department of Neurology (C.B.S.), Beth-Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; and Epilepsy Center (A.S.-B.), Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Germany
| | - Dale K Hesdorffer
- From the Center for Neuroscience Research (N.T.C., W.D.G.), Children's National Hospital, The George Washington University School of Medicine, Washington, DC; UCL NIHR BRC Great Ormond Street Institute of Child Health (J.H.C.), Member of ERN-EpiCARE, London; Great Ormond Street Hospital for Children (J.H.C.), NHS Trust, London; Young Epilepsy (J.H.C.), Lingfield, Surrey, UK; Department of Pediatric Clinical Epileptology (A.A.), Sleep Disorders and Functional Neurology, Member of ERN-EpiCARE; HFME (A.A.), Hospices Civils de Lyon, France; Epilepsy Research Unit (A.A.), Barcelona's Children Hospital San Juan de Dios, Member of the ERN EpiCARE, Spain; Epilepsy Research Centre (S.F.B.), University of Melbourne, Australia; Division of Pediatric Neurology (J.F.K.), Barrow Neurological Institute at Phoenix Children's Hospital; Hope for Hypothalamic Hamartomas (I.P.M., E.W., L.S.), Phoenix, AZ; Epilepsy Surgery Program (A.C.), Clinica de Epilepsia de Sao Paulo, Brazil; Department of Epidemiology (D.K.H.), Columbia University Medical Center, New York, NY; RTI International (B.L.K.), Rockville, MD; Department of Neurology (C.B.S.), Beth-Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; and Epilepsy Center (A.S.-B.), Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Germany
| | - Barbara L Kroner
- From the Center for Neuroscience Research (N.T.C., W.D.G.), Children's National Hospital, The George Washington University School of Medicine, Washington, DC; UCL NIHR BRC Great Ormond Street Institute of Child Health (J.H.C.), Member of ERN-EpiCARE, London; Great Ormond Street Hospital for Children (J.H.C.), NHS Trust, London; Young Epilepsy (J.H.C.), Lingfield, Surrey, UK; Department of Pediatric Clinical Epileptology (A.A.), Sleep Disorders and Functional Neurology, Member of ERN-EpiCARE; HFME (A.A.), Hospices Civils de Lyon, France; Epilepsy Research Unit (A.A.), Barcelona's Children Hospital San Juan de Dios, Member of the ERN EpiCARE, Spain; Epilepsy Research Centre (S.F.B.), University of Melbourne, Australia; Division of Pediatric Neurology (J.F.K.), Barrow Neurological Institute at Phoenix Children's Hospital; Hope for Hypothalamic Hamartomas (I.P.M., E.W., L.S.), Phoenix, AZ; Epilepsy Surgery Program (A.C.), Clinica de Epilepsia de Sao Paulo, Brazil; Department of Epidemiology (D.K.H.), Columbia University Medical Center, New York, NY; RTI International (B.L.K.), Rockville, MD; Department of Neurology (C.B.S.), Beth-Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; and Epilepsy Center (A.S.-B.), Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Germany
| | - Clifford B Saper
- From the Center for Neuroscience Research (N.T.C., W.D.G.), Children's National Hospital, The George Washington University School of Medicine, Washington, DC; UCL NIHR BRC Great Ormond Street Institute of Child Health (J.H.C.), Member of ERN-EpiCARE, London; Great Ormond Street Hospital for Children (J.H.C.), NHS Trust, London; Young Epilepsy (J.H.C.), Lingfield, Surrey, UK; Department of Pediatric Clinical Epileptology (A.A.), Sleep Disorders and Functional Neurology, Member of ERN-EpiCARE; HFME (A.A.), Hospices Civils de Lyon, France; Epilepsy Research Unit (A.A.), Barcelona's Children Hospital San Juan de Dios, Member of the ERN EpiCARE, Spain; Epilepsy Research Centre (S.F.B.), University of Melbourne, Australia; Division of Pediatric Neurology (J.F.K.), Barrow Neurological Institute at Phoenix Children's Hospital; Hope for Hypothalamic Hamartomas (I.P.M., E.W., L.S.), Phoenix, AZ; Epilepsy Surgery Program (A.C.), Clinica de Epilepsia de Sao Paulo, Brazil; Department of Epidemiology (D.K.H.), Columbia University Medical Center, New York, NY; RTI International (B.L.K.), Rockville, MD; Department of Neurology (C.B.S.), Beth-Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; and Epilepsy Center (A.S.-B.), Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Germany
| | - Andreas Schulze-Bonhage
- From the Center for Neuroscience Research (N.T.C., W.D.G.), Children's National Hospital, The George Washington University School of Medicine, Washington, DC; UCL NIHR BRC Great Ormond Street Institute of Child Health (J.H.C.), Member of ERN-EpiCARE, London; Great Ormond Street Hospital for Children (J.H.C.), NHS Trust, London; Young Epilepsy (J.H.C.), Lingfield, Surrey, UK; Department of Pediatric Clinical Epileptology (A.A.), Sleep Disorders and Functional Neurology, Member of ERN-EpiCARE; HFME (A.A.), Hospices Civils de Lyon, France; Epilepsy Research Unit (A.A.), Barcelona's Children Hospital San Juan de Dios, Member of the ERN EpiCARE, Spain; Epilepsy Research Centre (S.F.B.), University of Melbourne, Australia; Division of Pediatric Neurology (J.F.K.), Barrow Neurological Institute at Phoenix Children's Hospital; Hope for Hypothalamic Hamartomas (I.P.M., E.W., L.S.), Phoenix, AZ; Epilepsy Surgery Program (A.C.), Clinica de Epilepsia de Sao Paulo, Brazil; Department of Epidemiology (D.K.H.), Columbia University Medical Center, New York, NY; RTI International (B.L.K.), Rockville, MD; Department of Neurology (C.B.S.), Beth-Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; and Epilepsy Center (A.S.-B.), Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Germany
| | - William D Gaillard
- From the Center for Neuroscience Research (N.T.C., W.D.G.), Children's National Hospital, The George Washington University School of Medicine, Washington, DC; UCL NIHR BRC Great Ormond Street Institute of Child Health (J.H.C.), Member of ERN-EpiCARE, London; Great Ormond Street Hospital for Children (J.H.C.), NHS Trust, London; Young Epilepsy (J.H.C.), Lingfield, Surrey, UK; Department of Pediatric Clinical Epileptology (A.A.), Sleep Disorders and Functional Neurology, Member of ERN-EpiCARE; HFME (A.A.), Hospices Civils de Lyon, France; Epilepsy Research Unit (A.A.), Barcelona's Children Hospital San Juan de Dios, Member of the ERN EpiCARE, Spain; Epilepsy Research Centre (S.F.B.), University of Melbourne, Australia; Division of Pediatric Neurology (J.F.K.), Barrow Neurological Institute at Phoenix Children's Hospital; Hope for Hypothalamic Hamartomas (I.P.M., E.W., L.S.), Phoenix, AZ; Epilepsy Surgery Program (A.C.), Clinica de Epilepsia de Sao Paulo, Brazil; Department of Epidemiology (D.K.H.), Columbia University Medical Center, New York, NY; RTI International (B.L.K.), Rockville, MD; Department of Neurology (C.B.S.), Beth-Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; and Epilepsy Center (A.S.-B.), Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Germany
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Tripathi M, Maskara P, Sankhyan N, Sahu JK, Kumar R, Kumar N, Ahuja CK, Kaur P, Kaur R, Batish A, Mohindra S. Safety and Efficacy of Primary Hypofractionated Gamma Knife Radiosurgery for Giant Hypothalamic Hamartoma. Indian J Pediatr 2021; 88:1086-1091. [PMID: 33501606 DOI: 10.1007/s12098-020-03637-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 12/18/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To describe the feasibility, safety, efficacy, and complication profile of primary hypofractionated gamma knife radiosurgery (GKRS), and practical nuances of performing the same in pediatric patients. METHODS Three pediatric patients (age range 17-65 mo) underwent primary hypofractionated GKRS in 2-3 consecutive days with interfraction interval of 24 h. All patients had precocious puberty and were on GnRH analogue. Frame based GKRS done with 8.1-9.2 Gy radiation per fraction at 50% isodose in 2-3 fractions targeting the entire hamartoma volume. The mean target volume was 5.67 cc (4.45-7.39 cc). The authors followed these patients for clinical and endocrinological assessment at every 6 mo interval while the repeat MRI done at 6 mo and then annually. The seizure outcome analysis was done using Engel scale. RESULTS At a mean follow up of 27 mo (24-30 mo), 2 patients became Engel class 3 while one achieved Engel class 1 control. 2 patients showed halted pubertal growth with no additional hormonal aberration. 2 patients showed significant volumetric reduction (48% and 32%) and patchy necrosis inside the hypothalamic hamartoma (HH). There was no deficit in visual function, memory and cognition. One patient showed reduction in aggressiveness. CONCLUSION Giant HH are exceptionally difficult neurological diseases. Primary hypofractionated GKRS may be an alternative approach as mono/multitherapy with promising results and minimal complication.
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Affiliation(s)
- Manjul Tripathi
- Department of Neurosurgery, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India. .,National Institute of Health Research (NIHR) Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, UK.
| | - Prasant Maskara
- Department of Neurosurgery, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Naveen Sankhyan
- Department of Pediatric Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Jitendra Kumar Sahu
- Department of Pediatric Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Rakesh Kumar
- Department of Pediatric Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Narendra Kumar
- Department of Radiotherapy, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Chirag K Ahuja
- Department of Radiodiagnosis, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Parwinder Kaur
- Department of Neurosurgery, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Rupinder Kaur
- Department of Neurosurgery, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Aman Batish
- Department of Neurosurgery, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Sandeep Mohindra
- Department of Neurosurgery, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
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Conti F, Poujet L, Delverdier M, Lallemand EA, Benoit J. High dose rate interstitial 192‐Ir brachytherapy for the treatment of a recurrent dermal vascular hamartoma in a horse. EQUINE VET EDUC 2021. [DOI: 10.1111/eve.13550] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- F. Conti
- ONCOVET Villeneuve d'Ascq France
| | | | - M. Delverdier
- IHAP Université de Toulouse INRAE ENVT Toulouse France
| | - E. A. Lallemand
- InTheRes UMR1436 Université de Toulouse INRAE ENVT Toulouse France
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Mortini P, Albano L, Barzaghi LR, Losa M. Pituitary Surgery. Presse Med 2021; 50:104079. [PMID: 34687913 DOI: 10.1016/j.lpm.2021.104079] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 09/08/2021] [Accepted: 10/12/2021] [Indexed: 01/13/2023] Open
Abstract
Surgery, more specifically transsphenoidal approach, remains the primary treatment chosen for the majority of pituitary tumors (except for prolactinomas where medical treatment is indicated) allowing for pathologic analysis and complete or partial tumor removal. Transcranial approaches, employing craniotomies, are still needed in some patients with giant pituitary adenomas and in many of those harboring craniopharyngiomas. However, the surgical treatment of pituitary tumors is challenging because of their complex anatomical location and their heterogenous histology. Due to the proximity of critical structures, a successful surgical procedure may often not be achievable due to the high risks related to the procedure itself. Therefore, the treatment of pituitary tumors in 2020 commonly requires a multimodal approach, including surgery, radiosurgery, radiation therapy, and medical therapy. Recently, efforts have been made to develop intraoperative imaging, by increasing the diffusion of radiosurgery. Furthermore, the development of Pituitary Tumor Centers of Excellence (PTCOE) is becoming crucial to provide the optimal treatment for a single patient. There is in fact sufficient evidence that the best and optimal outcome in terms of tumor resection and correction of hormonal over secretion as well as the lowest rate of complications are obtained in centers of excellence with sufficiently experienced, specialized surgeons and a high patient load. Technological developments will probably even gain increasing importance in the future.
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Affiliation(s)
- Pietro Mortini
- Department of Neurosurgery and Gamma Knife Radiosurgery, I.R.C.C.S. San Raffaele Scientific Institute, Vita-Salute University, Via Olgettina 60, 20132 Milan, Italy.
| | - Luigi Albano
- Department of Neurosurgery and Gamma Knife Radiosurgery, I.R.C.C.S. San Raffaele Scientific Institute, Vita-Salute University, Via Olgettina 60, 20132 Milan, Italy; Neuroimaging Research Unit, Division of Neuroscience, IRCCS Ospedale San Raffaele, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
| | - Lina Raffaella Barzaghi
- Department of Neurosurgery and Gamma Knife Radiosurgery, I.R.C.C.S. San Raffaele Scientific Institute, Vita-Salute University, Via Olgettina 60, 20132 Milan, Italy
| | - Marco Losa
- Department of Neurosurgery and Gamma Knife Radiosurgery, I.R.C.C.S. San Raffaele Scientific Institute, Vita-Salute University, Via Olgettina 60, 20132 Milan, Italy
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Shirozu H, Masuda H, Kameyama S. Long-term seizure outcomes in patients with hypothalamic hamartoma treated by stereotactic radiofrequency thermocoagulation. Epilepsia 2021; 62:2697-2706. [PMID: 34541660 DOI: 10.1111/epi.17071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 08/25/2021] [Accepted: 09/03/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To investigate long-term seizure outcomes in patients with hypothalamic hamartoma (HH) following stereotactic radiofrequency thermocoagulation (SRT). METHODS A total of 131 patients with HH who underwent SRT and were followed for at least three years after the last SRT were enrolled. Seizure outcomes were evaluated for gelastic seizures (GS) and other types of seizures (nGS) separately using the International League Against Epilepsy classification. Classes 1 and 2 were considered seizure-free. Kaplan-Meier survival analyses were used to estimate the proportion remaining seizure-free after the first and last SRTs. Risk factors relating to outcomes were analyzed by log-rank tests and a multivariate Cox proportional hazards model. RESULTS Reoperation was performed in 34 patients (26.2%). Median total follow-up was 61 (range, 36-202) months. Seizure freedom was obtained in 116 patients (88.6%) for GS and 85 of 108 patients (78.7%) for nGS at the last follow-up. Mean GS-free survival times improved from after the first (64.1 [95%CI 57.3-70.9] months) to after the last SRT (80.2 [95%CI 75.7-84.8] months). About 90% of GS recurrences after the first SRT were found within 6 months, though a few patients recurred more than 2 years after the first SRT. On the other hand, mean nGS-free survival times after the first and last SRTs were not different between after the first SRT (84.4 [95%CI 73.0-90.7] months) and after the last SRT (83.1 [95%CI 74.1-92.0] months). There was no factor related to GS outcomes, but the significant factor for nGS-free survival after the last SRT was multiple previous treatments (p=0.01, hazard ratio=15.65, 95%CI 1.79-137.16). SIGNIFICANCE The last SRT was almost equivalent to achieving complete disconnection of HHs from the hypothalamus according to our strategy. Considering the epileptogenic network, GS outcomes depend on complete disconnection, whereas nGS outcomes are not affected by surgical factors but independency of secondary epileptogenesis.
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Affiliation(s)
- Hiroshi Shirozu
- Department of Functional Neurosurgery, National Hospital Organization Nishiniigata Chuo Hospital, Niigata, Japan.,Hypothalamic Hamartoma Center, National Hospital Organization Nishiniigata Chuo Hospital, Niigata, Japan
| | - Hiroshi Masuda
- Department of Functional Neurosurgery, National Hospital Organization Nishiniigata Chuo Hospital, Niigata, Japan.,Hypothalamic Hamartoma Center, National Hospital Organization Nishiniigata Chuo Hospital, Niigata, Japan
| | - Shigeki Kameyama
- Department of Neurosurgery, Niigata Seiro Hospital, Niigata, Japan
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Song JY, Lee JI, Shin HJ, Lee J, Lee J. Gamma-Knife Radiosurgery for Hypothalamic Hamartoma-Related Epilepsy. ANNALS OF CHILD NEUROLOGY 2021. [DOI: 10.26815/acn.2021.00360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Hamdi H, Albader F, Spatola G, Laguitton V, Trebuchon A, Bartolomei F, Regis J. Long-term cognitive outcome after radiosurgery in epileptic hypothalamic hamartomas and review of the literature. Epilepsia 2021; 62:1369-1381. [PMID: 33878213 DOI: 10.1111/epi.16896] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Revised: 03/17/2021] [Accepted: 03/18/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Epileptic patients with hypothalamic hamartoma (HH) frequently present cognitive impairments. Surgical techniques aiming at HH can be very efficient for epilepsy relief and cognitive improvement but are also demonstrated to carry a significant risk of additional reduction in memory function in these already disabled patients. Gamma knife radiosurgery (GKS) offers an efficient minimally invasive procedure. We evaluated the effect of stereotactic radiosurgery on cognitive outcome. METHODS We designed a prospective single-center case series study. Thirty-nine epileptic patients (median age = 17 years, range = 4-50) with HH underwent preoperative and postoperative testing of intelligence quotient (IQ; all patients), including a working memory component, and other memory function testing (for patients ≥16 years old). All patients were prospectively evaluated and underwent complete presurgical and postsurgical clinical, electrophysiological, endocrinal, and visual assessments. In all patients, the postoperative assessment was performed at least 3 years after radiosurgery. We explored what variables correlate with cognitive outcome. Literature review was done for other surgical techniques and their risks for cognitive complications after surgery. RESULTS No decline was observed in intellectual ability (including working memory) after GKS, and no memory decline was seen in adults. We observed significant improvement (>1 SD in z-score) in working memory index (46%) and processing speed index (35%), as well as improvement in full-scale IQ (24%), verbal comprehension index (11%), perceptual organization index (21%), verbal learning (20%), and visual learning (33%). Before GKS, the probability of seizure cessation was higher in patients with higher cognitive performance. After GKS, the cognitive improvement was significantly higher in the seizure-free patients compared to the non-seizure-free patients. SIGNIFICANCE We found clear cognitive improvement in a high percentage of patients but importantly no significant decline in intellectual ability (including working memory) and no decline in memory in adult patients 3 years after GKS. GKS compares favorably to the other surgical techniques in terms of cognitive outcome, with similar seizure freedom.
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Affiliation(s)
- Hussein Hamdi
- Department of Functional and Stereotactic Neurosurgery and Gamma Knife Radiosurgery, Timone University Hospital, Aix-Marseille University, Marseille, France.,Institute of Systems Neuroscience, Mixed Unit of Research 1106, National Institute of Health and Medical Research, Aix-Marseille University, Marseille, France.,Functional Neurosurgery and Stereotaxy Unit, Neurological Surgery Department, Tanta University, Tanta, Egypt
| | - Faisal Albader
- Department of Functional and Stereotactic Neurosurgery and Gamma Knife Radiosurgery, Timone University Hospital, Aix-Marseille University, Marseille, France
| | - Giorgio Spatola
- Department of Functional and Stereotactic Neurosurgery and Gamma Knife Radiosurgery, Timone University Hospital, Aix-Marseille University, Marseille, France
| | - Virginie Laguitton
- Institute of Systems Neuroscience, Mixed Unit of Research 1106, National Institute of Health and Medical Research, Aix-Marseille University, Marseille, France.,Department of Clinical Physiology, Mixed Unit of Research 1106, National Institute of Health and Medical Research, Timone University Hospital, Aix-Marseille University, Marseille, France
| | - Agnes Trebuchon
- Institute of Systems Neuroscience, Mixed Unit of Research 1106, National Institute of Health and Medical Research, Aix-Marseille University, Marseille, France.,Department of Clinical Physiology, Mixed Unit of Research 1106, National Institute of Health and Medical Research, Timone University Hospital, Aix-Marseille University, Marseille, France
| | - Fabrice Bartolomei
- Institute of Systems Neuroscience, Mixed Unit of Research 1106, National Institute of Health and Medical Research, Aix-Marseille University, Marseille, France.,Department of Clinical Physiology, Mixed Unit of Research 1106, National Institute of Health and Medical Research, Timone University Hospital, Aix-Marseille University, Marseille, France
| | - Jean Regis
- Department of Functional and Stereotactic Neurosurgery and Gamma Knife Radiosurgery, Timone University Hospital, Aix-Marseille University, Marseille, France.,Institute of Systems Neuroscience, Mixed Unit of Research 1106, National Institute of Health and Medical Research, Aix-Marseille University, Marseille, France
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Hamdi H, Ferrante P, Spatola G, Clawson W, McGonigal A, Daquin G, Villeneuve N, Laguitton V, Bartolomei F, Regis J. Epileptic hypothalamic hamartomas impact of topography on clinical presentation and radiosurgical outcome. Epilepsy Res 2021; 173:106624. [PMID: 33839515 DOI: 10.1016/j.eplepsyres.2021.106624] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 03/13/2021] [Accepted: 03/21/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Evidence exists for the role of the hypothalamic hamartoma's topography as a determinant for the clinical presentation. How the hamartoma relation to the hypothalamic structures can make clinical presentations, severity and surgery outcomes different from patient to patient is largely unknown. Our aim was to analyze the effect of fine anatomical topography on clinical spectrum and radiosurgery outcome. METHODS Forty-eight epileptic patients with hypothalamic hamartoma were treated by Gamma Knife Surgery and were reviewed for fine topography and morphology using magnetic resonance neuroimaging. We evaluated different topographic patterns; contact to prominent structures (the mammillary body, tuber cinereum and pituitary stalk), the degree of involvement within sagittally-oriented regions, (mammillary, tuberal, and supra optic) coronally-oriented zones (periventricular, medial, and lateral), lesion dimensions (length, width, and height),and volumes (total, intra-hypothalamic, and extra-hypothalamic volumes). This data were statistically analysed for correlation with all clinical variables and epilepsy surgery outcome. We reviewed all the classification protocols in the literature. RESULTS Focal onset impaired awareness seizures started at an earlier age of onset with larger hypothalamic hamartoma volume and dimensions. Lateral extension within the hypothalamus was associated with more severe epilepsy, higher seizure frequency, more severe psychiatric comorbidity, hetero-aggression, hyperkinesia, and school difficulties. Presence of precocious puberty was positively correlated to anterior-posterior extension; tuberal region involvement, hypothalamic hamartoma volume, and type III-VI. Larger hypothalamic hamartoma presented precocious puberty at an earlier age of onset. After Gamma Knife Surgery, epilepsy outcome was better and rapid when lesion is smaller. Post-radiosurgical transient increased seizures were present when the mammillary region was more involved. CONCLUSION Clinical presentation of epileptic hypothalamic hamartoma is significantly affected by fine topography patterns and invaded hypothalamic areas. Gamma Knife Radiosurgery effect is better and rapid in smaller hamartoma (Type I-III) and seizure outcome was not affected by the invaded hypothalamic areas.
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Affiliation(s)
- Hussein Hamdi
- Department of Functional and Stereotactic Neurosurgery and Gamma Knife, Timone University Hospital, Aix-Marseille University, Marseille, France; Aix Marseille Univ, INSERM, INS, Inst Neurosci Syst, Marseille, France; Functional Neurosurgery and Stereotaxy Unit, Neurological Surgery Department, Tanta University, Egypt.
| | - Patrizia Ferrante
- Department of Functional and Stereotactic Neurosurgery and Gamma Knife, Timone University Hospital, Aix-Marseille University, Marseille, France; Department of Medicine and Surgery, University of Salerno, Baronissi, Italy
| | - Giorgio Spatola
- Department of Functional and Stereotactic Neurosurgery and Gamma Knife, Timone University Hospital, Aix-Marseille University, Marseille, France; Aix Marseille Univ, INSERM, INS, Inst Neurosci Syst, Marseille, France
| | - Wesley Clawson
- Aix Marseille Univ, INSERM, INS, Inst Neurosci Syst, Marseille, France
| | - Aileen McGonigal
- Clinical Physiology Department, INSERM, UMR 1106 and Timone University Hospital, Aix-Marseille Université, Marseille, France
| | - Geraldine Daquin
- Clinical Physiology Department, INSERM, UMR 1106 and Timone University Hospital, Aix-Marseille Université, Marseille, France
| | - Nathalie Villeneuve
- Clinical Physiology Department, INSERM, UMR 1106 and Timone University Hospital, Aix-Marseille Université, Marseille, France
| | - Virginie Laguitton
- Clinical Physiology Department, INSERM, UMR 1106 and Timone University Hospital, Aix-Marseille Université, Marseille, France
| | - Fabrice Bartolomei
- Clinical Physiology Department, INSERM, UMR 1106 and Timone University Hospital, Aix-Marseille Université, Marseille, France
| | - Jean Regis
- Department of Functional and Stereotactic Neurosurgery and Gamma Knife, Timone University Hospital, Aix-Marseille University, Marseille, France; Aix Marseille Univ, INSERM, INS, Inst Neurosci Syst, Marseille, France
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Karakas C, Wilfong AA, Riviello JJ, Curry DJ, Ali I. Epileptic Spasms in a Large Hypothalamic Hamartoma Cohort. J Child Neurol 2021; 36:304-309. [PMID: 33170063 DOI: 10.1177/0883073820968652] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Hypothalamic hamartoma is rarely associated with epileptic spasms. We describe epileptic spasms in a large cohort of hypothalamic hamartoma patients. METHODS We performed a retrospective chart review between March 2011 and March 2020 to identify patients with hypothalamic hamartoma and epilepsy. RESULTS We identified 114 patients with hypothalamic hamartoma and epilepsy, only 3 male patients (2.6%) also had epileptic spasms. The epileptic spasms developed between 6 and 18 months of age. Epileptic spasms resolved with oral prednisolone in 1 and with vigabatrin in the second patient. The third patient continued epileptic spasms despite multiple antiepileptic drugs and partial resection of hypothalamic hamartoma. All 3 patients underwent laser-ablation of hypothalamic hamartoma at the age of 14, 29, and 63 months. The seizure burden decreased by 100%, 84%, and 93% at follow-up (3-47 months). CONCLUSIONS Epileptic spasms are rare in hypothalamic hamartoma patients and early laser-ablation could potentially treat epileptic spasms and all other seizure types associated with hypothalamic hamartoma.
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Affiliation(s)
- Cemal Karakas
- Department of Pediatrics, Section of Pediatric Neurology and Developmental Neuroscience, 12298Baylor College of Medicine, Houston, TX, USA.,Department of Neurology and Neurophysiology, 12298Baylor College of Medicine, Houston, TX, USA
| | - Angus A Wilfong
- Division of Pediatric Neurology, Phoenix Children's Hospital, Barrow Neurological Institute, Phoenix, AZ, USA
| | - James J Riviello
- Department of Pediatrics, Section of Pediatric Neurology and Developmental Neuroscience, 12298Baylor College of Medicine, Houston, TX, USA.,Department of Neurology and Neurophysiology, 12298Baylor College of Medicine, Houston, TX, USA
| | - Daniel J Curry
- Section of Pediatric Neurosurgery, Texas Children's Hospital, Houston, TX, USA
| | - Irfan Ali
- Department of Pediatrics, Section of Pediatric Neurology and Developmental Neuroscience, 12298Baylor College of Medicine, Houston, TX, USA.,Department of Neurology and Neurophysiology, 12298Baylor College of Medicine, Houston, TX, USA
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Yamaguchi T, Hori T, Hori H, Takasaki M, Abe K, Taira T, Ishii K, Watanabe K. Magnetic resonance-guided focused ultrasound ablation of hypothalamic hamartoma as a disconnection surgery: a case report. Acta Neurochir (Wien) 2020; 162:2513-2517. [PMID: 32617679 DOI: 10.1007/s00701-020-04468-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 06/18/2020] [Indexed: 11/24/2022]
Abstract
We report the case of a patient with hypothalamic hamartoma (HH) who was successfully treated with magnetic resonance-guided focused ultrasound (MRgFUS) for ablation as a disconnection surgery. A 26-year-old man with gelastic epilepsy had been diagnosed with HH at 3 years of age, and antiepileptic drugs were administered due to worsening episodes. Magnetic resonance imaging showed a sessile parahypothalamic hamartoma and MRgFUS ablation was performed, creating an oval-shaped lesion at the boundary area of the HH. Dramatic improvements in seizure symptoms were noted, and he was seizure-free on decreased antiepileptic drugs without any adverse events over the 1-year follow-up period.
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Affiliation(s)
- Toshio Yamaguchi
- Research Institute of Diagnostic Radiology, Shin-Yurigaoka General Hospital, 255 Furusawa-tsuko Asaoku, Kawasaki, Kanagawa, 215-0026, Japan.
| | - Tomokatu Hori
- Department of Neurosurgery, Moriyama Neurological Center Hospital, Tokyo, Japan
| | - Hiroki Hori
- Department of Radiology, Shin-Yurigaoka General Hospital, Kanagawa, Japan
| | - Masahito Takasaki
- Department of Anesthesiology, Shin-Yurigaoka General Hospital, Kanagawa, Japan
| | - Keiichi Abe
- Department of Neurosurgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Takaomi Taira
- Department of Neurosurgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Kenji Ishii
- Neuroimaging Research, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Kazuo Watanabe
- Southern Tohoku Research Institute for Neuroscience, Fukushima, Japan
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40
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Bourdillon P, Ferrand-Sorbet S, Apra C, Chipaux M, Raffo E, Rosenberg S, Bulteau C, Dorison N, Bekaert O, Dinkelacker V, Le Guérinel C, Fohlen M, Dorfmüller G. Surgical treatment of hypothalamic hamartomas. Neurosurg Rev 2020; 44:753-762. [PMID: 32318922 DOI: 10.1007/s10143-020-01298-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 03/29/2020] [Accepted: 03/31/2020] [Indexed: 12/15/2022]
Abstract
Hypothalamic hamartomas are aberrant masses, composed of abnormally distributed neurons and glia. Along endocrine and cognitive symptoms, they may cause epileptic seizures, including the specific gelastic and dacrystic seizures. Surgery is the treatment of drug-resistant hamartoma epilepsy, with associated positive results on endocrine, psychiatric, and cognitive symptoms. Recently, alternatives to open microsurgical treatment have been proposed. We review these techniques and compare their efficacy and safety. Open resection or disconnection of the hamartoma, either through pterional, transcallosal, or transventricular approach, leads to good epileptological control, but its high complication rate, up to 30%, limits its indications. The purely cisternal peduncular forms remain the only indication of open, pterional approach, while other strategies have been developed to overcome the neurological, endocrine, behavioral, or cognitive complications. Laser and radiofrequency thermocoagulation-based disconnection through robot-guided stereo-endoscopy has been proposed as an alternative to open microsurgical resection and stereotactic destruction. The goal is to allow safe and complete disconnection of a possibly complex attachment zone, through a single intraparenchymal trajectory which allows multiple laser or radiofrequency probe trajectory inside the ventricle. The efficacy was high, with 78% of favorable outcome, and the overall complication rate was 8%. It was especially effective in patients with isolated gelastic seizures and pure intraventricular hamartomas. Stereotactic radiosurgery has proved as efficacious and safer than open microsurgery, with around 60% of seizure control and a very low complication rate. Multiple stereotactic thermocoagulation showed very interesting results with 71% of seizure freedom and 2% of permanent complications. Stereotactic laser interstitial thermotherapy (LiTT) seems as effective as open microsurgery (from 76 to 81% of seizure freedom) but causes up to 20% of permanent complications. This technique has however been highly improved by targeting only the epileptogenic onset zone in the hamartoma, as shown on preoperative functional MRI, leading to an improvement of epilepsy control by 45% (92% of seizure freedom) with no postoperative morbidity. All these results suggest that the impact of the surgical procedure does not depend on purely technical matters (laser vs radiofrequency thermocoagulation or stereotactic vs robot-guided stereo-endoscopy) but relies on the understanding of the epileptic network, including inside the hamartoma, the aim being to plan an effective disconnection or lesion of the epileptogenic part while sparing the adjacent functional structures.
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Affiliation(s)
- Pierre Bourdillon
- Department of Neurosurgery, Rothschild Foundation Hospital, 29 Rue Manin, 75019, Paris, France. .,Department of Pediatric Neurosurgery, Rothschild Foundation Hospital, Paris, France. .,Sorbonne Université, Paris, France. .,INSERM U1127, CNRS, UMR7225, Brain and Spine Institute, Paris, France.
| | - S Ferrand-Sorbet
- Department of Pediatric Neurosurgery, Rothschild Foundation Hospital, Paris, France
| | - C Apra
- Sorbonne Université, Paris, France.,INSERM U1127, CNRS, UMR7225, Brain and Spine Institute, Paris, France.,Department of Neurosurgery, Pitié-Salpêtrière Hospital, Paris, France
| | - M Chipaux
- Department of Pediatric Neurosurgery, Rothschild Foundation Hospital, Paris, France
| | - E Raffo
- Department of Pediatric Neurosurgery, Rothschild Foundation Hospital, Paris, France.,Université de Lorraine, Nancy, France
| | - S Rosenberg
- Department of Pediatric Neurosurgery, Rothschild Foundation Hospital, Paris, France
| | - C Bulteau
- Department of Pediatric Neurosurgery, Rothschild Foundation Hospital, Paris, France.,Université de Paris, Paris, France
| | - N Dorison
- Department of Pediatric Neurosurgery, Rothschild Foundation Hospital, Paris, France
| | - O Bekaert
- Department of Pediatric Neurosurgery, Rothschild Foundation Hospital, Paris, France
| | - V Dinkelacker
- Department of Neurology, Rothschild Foundation Hospital, Paris, France
| | - C Le Guérinel
- Department of Neurosurgery, Rothschild Foundation Hospital, 29 Rue Manin, 75019, Paris, France
| | - M Fohlen
- Department of Pediatric Neurosurgery, Rothschild Foundation Hospital, Paris, France
| | - G Dorfmüller
- Department of Pediatric Neurosurgery, Rothschild Foundation Hospital, Paris, France
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Dupic G, Biau J, Lemaire JJ, Ortholan C, Clavelou P, Lapeyre M, Colin P, Khalil T. [Functional stereotactic radiosurgery: Indications and perspectives]. Cancer Radiother 2020; 24:166-173. [PMID: 32220562 DOI: 10.1016/j.canrad.2020.01.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 01/07/2020] [Accepted: 01/13/2020] [Indexed: 01/03/2023]
Abstract
Stereotactic radiosurgery (SRS) is a non-invasive technique that enables to create brain focal lesions with a high precision and localization. Thus, functional brain disorders can be treated by SRS in case of pharmacoresistance or inoperability. To date, treatment of trigeminal neuralgia is the most described and known indication. Other indications will be developed in the future like movement disorders, refractory epilepsy, obsessive compulsive disorder and severe depression. We present here a review of actual and future indications of functional brain SRS with their level of evidence. All these SRS treatments have to be strictly conducted by trained teams with an excellent collaboration between radiation physicists, medical physicists, neurosurgeons, neurologists, psychiatrists and probably neuroradiologists.
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Affiliation(s)
- G Dupic
- Département de radiothérapie, centre Jean-Perrin, 58, rue Montalembert, 63000 Clermont-Ferrand, France.
| | - J Biau
- Département de radiothérapie, centre Jean-Perrin, 58, rue Montalembert, 63000 Clermont-Ferrand, France
| | - J J Lemaire
- Département de neurochirurgie, centre hospitalier universitaire Gabriel-Montpied, 58, rue Montalembert, 63000 Clermont-Ferrand, France
| | - C Ortholan
- Département de radiothérapie, centre hospitalier Princesse-Grace, 1, avenue Pasteur, 98000 Monaco, France
| | - P Clavelou
- Département de neurologie, centre hospitalier universitaire Gabriel-Montpied, 58, rue Montalembert, 63000 Clermont-Ferrand, France
| | - M Lapeyre
- Département de radiothérapie, centre Jean-Perrin, 58, rue Montalembert, 63000 Clermont-Ferrand, France
| | - P Colin
- Département de radiothérapie, Institut du cancer Courlancy, 38, rue de Courlancy, 51100 Reims, France
| | - T Khalil
- Département de neurochirurgie, centre hospitalier universitaire Gabriel-Montpied, 58, rue Montalembert, 63000 Clermont-Ferrand, France
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Ferrand-Sorbets S, Fohlen M, Delalande O, Zuber K, Bulteau C, Levy M, Chamard P, Taussig D, Dorison N, Bekaert O, Tisdall M, Chipaux M, Dorfmüller G. Seizure outcome and prognostic factors for surgical management of hypothalamic hamartomas in children. Seizure 2020; 75:28-33. [DOI: 10.1016/j.seizure.2019.11.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 11/25/2019] [Accepted: 11/27/2019] [Indexed: 10/25/2022] Open
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Shirozu H, Masuda H, Kameyama S. Repeat stereotactic radiofrequency thermocoagulation in patients with hypothalamic hamartoma and seizure recurrence. Epilepsia Open 2020; 5:107-120. [PMID: 32140649 PMCID: PMC7049799 DOI: 10.1002/epi4.12378] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 01/02/2020] [Accepted: 01/04/2020] [Indexed: 11/09/2022] Open
Abstract
Objective To evaluate the feasibility of repeat stereotactic radiofrequency thermocoagulation (re‐SRT) for patients with hypothalamic hamartoma (HH) and to clarify clinical and surgical factors for seizure outcomes. Methods Hypothalamic hamartoma patients with gelastic seizures (GSs) who underwent SRT were retrospectively reviewed. Seizure outcomes were evaluated separately for GS and other types of seizures (non‐GS). Surgical complications were compared between re‐SRT and first SRT. Clinical and surgical factors related to both seizure recurrences after first SRT and final seizure outcomes were analyzed. Results Participants comprised 150 patients (92 males; median age at surgery, 8 years; range, 1.7‐50 years). Of those, 122 (81.3%) had non‐GS. Forty‐three patients (28.7%) underwent re‐SRT. Freedom from GS was achieved by first SRT in 103 patients (68.7%), second SRT in 30/40 (67.5%), third SRT in 3/10 (30.0%), and fourth SRT in 2/3 (66.7%). Finally, 135 patients (90.0%) became GS‐free. Ninety patients (73.8%) achieved non‐GS freedom, with first SRT in all except one case. Transient complications were more frequent with first SRT (118/150, 78.7%) than re‐SRT (35/56, 62.5%), whereas persistent complications were more frequent with re‐SRT (7/56, 12.5%) than with first SRT (3/150, 2.0%). Multivariate analyses revealed only younger age at surgery (≤1 year) as related to GS recurrence after first SRT, with no variables affecting final GS outcomes. Meanwhile, seizure type (tonic seizure), intellectual disability, and genetic syndromes were significant factors for both non‐GS recurrence and final outcomes. Multiple previous treatments were significantly related to final non‐GS outcomes as well. Size and subtype of HH and surgical factors were unrelated to seizure outcomes. Significance Repeat stereotactic radiofrequency thermocoagulation provides potential opportunities to achieve freedom from recurrent GS, albeit with increased risks of persistent complications. Non‐GS and intellectual disability could offer early surgical indications, and repeated ineffective treatments should be avoided.
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Affiliation(s)
- Hiroshi Shirozu
- Department of Functional Neurosurgery National Hospital Organization Nishiniigata Chuo Hospital Niigata Japan.,Hypothalamic Hamartoma Center National Hospital Organization Nishiniigata Chuo Hospital Niigata Japan
| | - Hiroshi Masuda
- Department of Functional Neurosurgery National Hospital Organization Nishiniigata Chuo Hospital Niigata Japan.,Hypothalamic Hamartoma Center National Hospital Organization Nishiniigata Chuo Hospital Niigata Japan
| | - Shigeki Kameyama
- Department of Functional Neurosurgery National Hospital Organization Nishiniigata Chuo Hospital Niigata Japan.,Hypothalamic Hamartoma Center National Hospital Organization Nishiniigata Chuo Hospital Niigata Japan.,Department of Neurosurgery Saiseikai Niigata Hospital Niigata Japan
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Albano L, Losa M, Flickinger J, Mortini P, Minniti G. Radiotherapy of Parasellar Tumours. Neuroendocrinology 2020; 110:848-858. [PMID: 32126559 DOI: 10.1159/000506902] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 03/02/2020] [Indexed: 11/19/2022]
Abstract
Parasellar tumours represent a wide group of intracranial lesions, both benign and malignant. They may arise from several structures located within the parasellar area or they may infiltrate or metastasize this region. The treatment of the tumours located in these areas is challenging because of their complex anatomical location and their heterogenous histology. It often requires a multimodal approach, including surgery, radiation therapy (RT), and medical therapy. Due to the proximity of critical structures and the risks of side effects related to the procedure, a successful surgical resection is often not achievable. Thus, RT plays a crucial role in the treatment of several parasellar tumours. Conventional fractionated RT and modern radiation techniques, like stereotactic radiosurgery and proton beam RT, have become a standard management option, in particular for cases with residual or recurrent tumours after surgery and for those cases where surgery is contraindicated. This review examines the role of RT in parasellar tumours analysing several techniques, outcomes and side effects.
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Affiliation(s)
- Luigi Albano
- Department of Neurosurgery and Gamma Knife Radiosurgery, I.R.C.C.S. San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
- Neuroimaging Research Unit, Division of Neuroscience, Institute of Experimental Neurology, I.R.C.C.S. San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
| | - Marco Losa
- Department of Neurosurgery and Gamma Knife Radiosurgery, I.R.C.C.S. San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
| | - John Flickinger
- Department of Radiation Oncology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Pietro Mortini
- Department of Neurosurgery and Gamma Knife Radiosurgery, I.R.C.C.S. San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
| | - Giuseppe Minniti
- Radiation Oncology Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy,
- UPMC Hillman Cancer Center San Pietro Hospital, Rome, Italy,
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Conde Blanco E, Anciones Martín C, Manzanares I, Gil López F, Roldán P, Donaire A, Rumiá J, Carreño M. Hypothalamic hamartomas in adulthood: Clinical spectrum and treatment outcome-A unicenter experience. Brain Behav 2019; 9:e01412. [PMID: 31578831 PMCID: PMC6851795 DOI: 10.1002/brb3.1412] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 07/01/2019] [Accepted: 07/28/2019] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION Clinical manifestations of the hypothalamic hamartoma-epilepsy syndrome (HH-ES) in adulthood are variable. Efficacy of therapeutic options and outcome are diverse. METHODS Retrospective study of adult patients diagnosed with a HH in magnetic resonance imaging and epilepsy who attended our tertiary Epilepsy Unit between 2003 and 2018. We report the clinical and electroencephalographic features of a series of adult patients with HH and related epilepsy seen in our center together with the treatments and seizure outcome. RESULTS We describe a series of eight patients. Five males (62.5%), median age at evaluation was 28.5 years (IQR: 15.5). Clinical manifestations included focal with preserved and impaired awareness emotional seizures (gelastic seizures [GS]) in six patients (75%), focal tonic, atonic with impaired awareness and focal to bilateral tonic-clonic seizures. Mild GS were the only symptom in one patient. Three patients (37.5%) had endocrinological disturbances such as obesity and hypothyroidism. Fifty percent of the patients showed psychiatric comorbidity such as anxiety disorder and aggressiveness, and two patients had psychomotor delay. Seven patients (87.7%) had drug-resistant seizures and three of them were treated with radiosurgery. Out of the treated group, only one (33.3%) became seizure-free 2 years after surgery but developed psychiatric problems. The other two patients had an Engel IV outcome and received a vagal nerve stimulation (VNS) implant. VNS did not lead to changes either in intensity nor in seizure frequency. CONCLUSIONS Hypothalamic hamartoma-epilepsy syndrome clinical manifestations in adult patients are as variable as at pediatric age. Outcome of therapeutic options such as radiosurgery or VNS may be poorer at this stage.
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Affiliation(s)
| | | | - Isabel Manzanares
- Epilepsy Unit, Department of Neurology, Hospital Clinic, Barcelona, Spain
| | | | - Pedro Roldán
- Epilepsy Unit, Department of Neurology, Hospital Clinic, Barcelona, Spain
| | - Antonio Donaire
- Epilepsy Unit, Department of Neurology, Hospital Clinic, Barcelona, Spain
| | - Jordi Rumiá
- Epilepsy Unit, Department of Neurology, Hospital Clinic, Barcelona, Spain
| | - Mar Carreño
- Epilepsy Unit, Department of Neurology, Hospital Clinic, Barcelona, Spain
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Malformations of cortical development: New surgical advances. Rev Neurol (Paris) 2019; 175:183-188. [DOI: 10.1016/j.neurol.2019.01.392] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 10/23/2018] [Accepted: 01/04/2019] [Indexed: 11/18/2022]
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Magnetic Resonance–Guided Laser Interstitial Thermal Therapy Versus Stereotactic Radiosurgery for Medically Intractable Temporal Lobe Epilepsy: A Systematic Review and Meta-Analysis of Seizure Outcomes and Complications. World Neurosurg 2019; 122:e32-e47. [DOI: 10.1016/j.wneu.2018.08.227] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 08/29/2018] [Accepted: 08/31/2018] [Indexed: 11/23/2022]
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Romanelli P. CyberKnife® Radiosurgery as First-line Treatment for Catastrophic Epilepsy Caused by Hypothalamic Hamartoma. Cureus 2018; 10:e2968. [PMID: 30221096 PMCID: PMC6136885 DOI: 10.7759/cureus.2968] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Hypothalamic hamartomas (HH) are deep-seated lesions often associated with catastrophic epilepsy (an epileptic syndrome characterized by severe, drug-refractory seizures eventually leading to mental retardation and death). Radical microsurgical resection is not feasible for lesions located within the wall of the third ventricle inside the hypothalamus. Frame-based stereotactic radiosurgery has been reported as an effective treatment modality for small- to medium-size intrahypothalamic hamartomas, providing excellent seizure outcomes without lasting complications. This report describes the use of frameless image-guided robotic radiosurgery (CyberKnife® Radiosurgery System) as a first-line treatment in two children with catastrophic epilepsy induced by HH. Both patients experienced multiple-daily complex partial and gelastic seizures, as well as almost daily generalized seizures. The prescribed dose was 16 Gy (to the 65% isodose for case I; to the 70% isodose for case II). Lesional volume was 11.5 cc (case I) and 8.9 cc (case II). A steady reduction of the seizure frequency and severity was achieved after the treatment, starting about three months after the treatment. The generalized seizures disappeared within one year, while complete resolution of the gelastic seizures required up to 18 months. No seizure recurrence and no radiation-induced side effects or complications were witnessed over a follow-up period of ten years and eight months (case I) and nine years and seven months (case II) since the treatment. CyberKnife radiosurgery proved to be a safe and effective non-invasive first-line treatment in these two children with catastrophic epilepsy caused by HH.
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Cook MJ. "Truths and roses have thorns about them" - Henry David Thoreau. Epilepsia 2018; 59:1208-1209. [PMID: 29873820 DOI: 10.1111/epi.14433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/02/2018] [Indexed: 11/27/2022]
Affiliation(s)
- Mark J Cook
- Department of Medicine and Engineering, University of Melbourne, Melbourne, VIC, Australia
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Abstract
The goal of any epilepsy surgery is to improve patient's quality of life by achieving seizure freedom or by reducing the frequency of severely debilitating seizures. To achieve this goal, non-invasive and invasive diagnostic methods must precisely delineate the epileptogenic zone (EZ), which is defined as the area that needs to be resected to obtain seizure freedom. At the same time, the correct identification of eloquent brain areas is inevitable to avoid new neurological deficits from surgery. In recent years, the technical advances in diagnostics have enabled us to achieve these goals in an increasing number of cases. As a consequence, and with new surgical treatment options available, the number of patients who might benefit from epilepsy surgery is constantly increasing. Especially in pediatric epilepsy, early surgical intervention is becoming frequently advocated as it has been shown to improve cognitive and behavioral outcome. Specialized epilepsy centers and multidisciplinary teams are required to provide adequate care and treatment. The goal of this review is to describe important diseases that are accessible to epilepsy surgery and to give an overview of current diagnostic methods. The focus lies on established as well as novel techniques in epilepsy surgery. The presurgical work-up and patient selection is outlined.
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Affiliation(s)
- Johannes Herta
- Department of Neurosurgery, Vienna General Hospital, Medical University of Vienna, Vienna, Austria
| | - Christian Dorfer
- Department of Neurosurgery, Vienna General Hospital, Medical University of Vienna, Vienna, Austria -
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