Management of
hypothalamic hamartoma with intractable
gelastic epilepsy remains controversial. We have used stereotactic
thermocoagulation for treatment of
hypothalamic hamartoma with intractable
gelastic epilepsy since 1997. Herein, we review our experience in five cases to clarify the usefulness of this treatment. A total of five patients with
hypothalamic hamartoma were treated by stereotactic
thermocoagulation at our hospital during the period October 1997 through February 2004. In all patients, the
hamartoma was less than 10mm in diameter and was located on the floor of the third ventricle with sessile attachment to the wall. To identify ictal onset, chronic intracranial electroencephalography was performed in three patients with the use of a depth
electrode implanted in the
hamartoma. Attempts were made to induce gelastic seizure by electrical stimulation of the
hamartoma in three patients. After magnetic resonance imaging-guided targeting, radiofrequency
thermocoagulation of the boundary between the
hamartoma and normal hypothalamus was performed to achieve disconnection effects. Marked reductions in seizure frequency were obtained in all cases, with three patients becoming seizure-free after the procedure. No
intraoperative complications occurred except in one patient who experienced acute and transient panidrosis with hot flushes during coagulation. Our results suggest that stereotactic
thermocoagulation of
hypothalamic hamartoma is an acceptable treatment option for patients with intractable gelastic
seizures.