Magnetic Resonance Imaging-Guided Laser Interstitial Thermal Therapy for the Treatment of Hypothalamic Hamartomas: A Retrospective Review.

Abstract

BACKGROUND:

Hypothalamic hamartomas (HH) are rare lesions associated with treatment-resistant epilepsy. Open surgery results in modest seizure control (about 50%) but has a significant associated morbidity. Radiosurgery is limited to a subset of patients due to latent therapeutic effects. Magnetic resonance imaging-guided laser interstitial thermal therapy (LITT) offers a novel minimally invasive option.

OBJECTIVE:

To evaluate a single center's outcomes for the LITT treatment of HH.

METHODS:

We retrospectively reviewed our experience with LITT for the treatment of HH using our institution's prospectively maintained patient database.

RESULTS:

Eighteen patients (mean age, 21.1 yr; median age, 11 yr) underwent 21 total LITT treatments for HH. Mean follow-up was 17.4 mo. The length of stay was 1 night for 16 (89%) patients. At the end of follow-up, 11 of 18 patients (61%) had full disconnection of the HH, and 12 of 15 (80%) patients with gelastic seizures and 5 (56%) of 9 patients with nongelastic seizures were seizure free (International League Against Epilepsy Class 1). Immediate complications included a 39% (7/18) incidence of neurological deficits, including 1 case of hemiparesis. At the end of follow-up, 22% of patients (4/18) had persistent deficits. The hypothyroidism that occurred was delayed in 11% of patients (2/18), as was short-term memory loss (22%, 4/18) and weight gain (22%, 4/18).

CONCLUSION:

LITT therapy for HH can achieve excellent rates of seizure control with low morbidity and a short postoperative stay in a majority of patients. Additional research is needed to assess the durability of results and the full spectrum of cognitive outcomes.

• Authors: David S Xu, Tsinsue Chen, Randall J Hlubek, Ruth E Bristol, Kris A Smith, Francisco A Ponce, John F Kerrigan, Peter Nakaji
• Journal: Neurosurgery (Neurosurgery) Vol. 83 Issue 6 Pg. 1183-1192 (12 01 2018) ISSN: 1524-4040 [Electronic] United States
• PMID: 29346599 (Publication Type: Case Reports, Journal Article, Review)

Topics

• Adolescent
• Adult
• Aged
• Child
• Child, Preschool
• Female
• Hamartoma (complications, surgery)
• Humans
• Hypothalamic Diseases (complications, surgery)
• Laser Therapy (adverse effects, methods)
• Magnetic Resonance Imaging
• Male
• Middle Aged
• Postoperative Complications (epidemiology)
• Retrospective Studies
• Seizures (etiology, prevention & control)
• Surgery, Computer-Assisted (methods)
• Treatment Outcome
• Young Adult