Abstract | BACKGROUND AND PURPOSE: Surgical resection of hypothalamic hamartomas (HHs) associated with drug-resistant gelastic epilepsy carries a considerable risk of neurological and endocrine morbidity. Alternative surgical routes and techniques have therefore been proposed, especially for broadly attached lesions and for those with a third ventricular location. METHODS: We present an updated series of 43 patients (aged nine months to 34 years), operated on from 1998 through 2005 at our institution. The hamartoma was disconnected using a microsurgical pterional approach of those lesions extending from the hypothalamic floor downward into the interpeduncular cistern. When the HH presented as a paramedian mass, partly or exclusively bulging into the third ventricle, with a rather vertical plane of attachment, we chose a frameless stereotactic endoscopic technique to disconnect the lesion. In several of our patients, both methods were applied subsequently. RESULTS: Surgery-related morbidity was lower with the ventricular endoscopic technique. Twenty-one patients (50%) are seizure-free and two patients (5%) almost seizure-free, while in 17 patients (40%), there was a significant seizure reduction. Two patients (5%) had no postoperative improvement. According to the different topographic features of the HHs, for which we have recently proposed a classification into four subtypes, the intraventricularly located hamartoma had the best prognosis following endoscopic disconnection. Ten of the 12 patients (83%) with this HH location became seizure-free. CONCLUSIONS: Resection of epilepsy-related HHs can be replaced by disconnective procedures. Our results confirm their feasibility and acceptable morbidity, with particularly good seizure outcome in patients with intraventricularly located HHs.
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Authors | G Dorfmüller, M Fohlen, C Bulteau, O Delalande |
Journal | Neuro-Chirurgie
(Neurochirurgie)
Vol. 54
Issue 3
Pg. 315-9
(May 2008)
ISSN: 0028-3770 [Print] France |
Vernacular Title | Déconnexion chirurgicale des hamartomes hypothalamiques. |
PMID | 18452954
(Publication Type: English Abstract, Journal Article)
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Topics |
- Adolescent
- Adult
- Cerebral Ventricles
(pathology)
- Child
- Child, Preschool
- Endoscopy
- Epilepsy
(classification, etiology)
- Female
- Hamartoma
(complications, pathology, surgery)
- Humans
- Hypothalamic Diseases
(complications, pathology, surgery)
- Infant
- Magnetic Resonance Imaging
- Male
- Neurosurgical Procedures
(adverse effects)
- Postoperative Complications
(epidemiology)
- Radiosurgery
- Seizures
(surgery)
- Treatment Outcome
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