A Special Approach for Stereotactic Radiofrequency Thermocoagulation of Hypothalamic Hamartomas With Bilateral Attachments to the Hypothalamus: The Transthird Ventricular Approach to the Contralateral Attachment.

Abstract

BACKGROUND:

Disconnection surgery for the treatment of epileptic hypothalamic hamartomas (HHs) is strategically difficult in cases with complex-shaped HHs, especially with bilateral hypothalamic attachments, despite its effectiveness.

OBJECTIVE:

To evaluate the feasibility of a new approach for stereotactic radiofrequency thermocoagulation (SRT) using penetration of the third ventricle (SRT-TT) aiming to disconnect bilateral hypothalamic attachments in a single-staged, unilateral procedure.

METHODS:

Ninety patients (median age at surgery, 5.0 years) who had HHs with bilateral hypothalamic attachments and were followed for at least 1 year after their last SRT were retrospectively reviewed.

RESULTS:

Thirty-three patients underwent SRT-TT as initial surgery. Of the 58 patients after mid-2013 when SRT-TT was introduced, 33 underwent SRT-TT and 12 (20.7%) required reoperation (ReSRT), whereas 20 of 57 patients (35.1%) without SRT-TT underwent reoperation. Reoperation was required in significantly fewer patients after mid-2013 (n = 12 of 58, 20.7%) than before mid-2013 (n = 15 of 32, 46.9%) ( P = .01). Final seizure freedoms were not different between before and after mid-2013 (gelastic seizure freedom, n = 30 [93.8%] vs n = 49 [84.5%] and other types of seizure freedom, n = 21 of 31 [67.7%] vs n = 32 of 38 [84.2%]). Persistent complications were less in SRT-TT than in ReSRT using the bilateral approach, but not significantly. However, hormonal replacement was required significantly more often in ReSRT using the bilateral approach (4 of 9, 44.4%) than in SRT-TT (3 of 32, 9.4%) ( P = .01).

CONCLUSION:

SRT-TT enabled disconnection of bilateral attachments of HHs in a single-staged procedure, which reduced the additional invasiveness of reoperation. Moreover, SRT-TT reduced damage to the contralateral hypothalamus, with fewer endocrinological complications than the bilateral approach.

• Authors: Hiroshi Shirozu, Hiroshi Masuda, Shigeki Kameyama
• Journal: Neurosurgery (Neurosurgery) Vol. 91 Issue 2 Pg. 295-303 (08 01 2022) ISSN: 1524-4040 [Electronic] United States
• PMID: 35394461 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © Congress of Neurological Surgeons 2022. All rights reserved.

Topics

• Electrocoagulation (methods)
• Hamartoma
• Humans
• Hypothalamic Diseases (complications, surgery)
• Hypothalamus (surgery)
• Magnetic Resonance Imaging
• Radiosurgery (methods)
• Retrospective Studies
• Treatment Outcome