Seizure outcome and complications following hypothalamic hamartoma treatment in adults: endoscopic, open, and Gamma Knife procedures
- 1 August 2012
- journal article
- Published by Journal of Neurosurgery Publishing Group (JNSPG) in Journal of Neurosurgery
- Vol. 117 (2), 255-261
- https://doi.org/10.3171/2012.5.jns112256
Abstract
This study aimed at identifying outcomes with respect to seizures, morbidity, and mortality in adult patients undergoing resective or Gamma Knife surgery (GKS) to treat intractable epilepsy associated with hypothalamic hamartoma (HH). Adult patients undergoing surgical treatment for HH-related epilepsy were prospectively monitored at a single center for complications and seizure outcome by using a proprietary database. Preintervention and postintervention data for patients 18 years of age and older, and with at least 1 year of follow-up, were analyzed, with specific attention to seizure control, complications, hormonal status, and death. Forty adult patients were found in the database (21 were women). The median HH volume was 0.54 cm(3). In 70% of patients, it was located inside the third ventricle, attached unilaterally and vertically to the hypothalamus (Delalande Type II). Most patients (26) underwent an endoscopic resection, 10 patients had a transcallosal or other type of open (pterional or orbitozygomatic) resection, and 4 patients chose GKS. Twenty-nine percent became seizure free in the long term, and overall a majority of patients (55%) reported at least > 90% seizure improvement. Only 3 patients were ultimately able to discontinue anticonvulsants, whereas most patients were taking an average of 2 antiepileptic drugs pre- and postoperatively. The only factor significantly correlated with seizure-free outcome was the absence of mental retardation. The HH volume, HH type, and amount of resection or disconnection were not correlated to seizure freedom. A total of 4 patients (10%) died, 2 immediately after surgery and 2 later. All of them had undergone a resection, as opposed to GKS, and still had seizures. Postoperatively, persistent neurological deficits were seen in 1 patient; 34% of patients had mild hormonal problems; and 59% experienced weight gain of at least 6.8 kg (average gain 12.7 kg). Surgical or GKS procedures in adults with HH provided seizure freedom in one-third of patients. The only significant favorable prognostic factor was the absence of mental retardation. The overall mortality rate was high, at 10%. Other important morbidities were persistent hormonal disturbances and weight gain.This publication has 15 references indexed in Scilit:
- Semiologic aspects of epileptic seizures in 31 patients with hypothalamic hamartomaEpilepsia, 2010
- Outcome and predictors of interstitial radiosurgery in the treatment of gelastic epilepsyNeurology, 2008
- Endoscopic resection of hypothalamic hamartomas for refractory symptomatic epilepsyNeurology, 2008
- Endoscopic Resection of Hypothalamic Hamartoma for Refractory Epilepsy: Preliminary ReportSeminars in Pediatric Neurology, 2007
- Hypothalamic Hamartoma Treatment: Surgical Resection With the Transcallosal ApproachSeminars in Pediatric Neurology, 2007
- Epilepsy in Hypothalamic Hamartoma: Clinical and EEG FeaturesSeminars in Pediatric Neurology, 2007
- Transcallosal Resection of Hypothalamic Hamartoma for Intractable EpilepsyEpilepsia, 2006
- Epilepsy related to hypothalamic hamartomas: surgical management with special reference to gamma knife surgeryChild's Nervous System, 2006
- Disconnecting Surgical Treatment of Hypothalamic Hamartoma in Children and Adults With Refractory Epilepsy and Proposal of a New Classification.Neurologia medico-chirurgica, 2003
- Hypothalamic hamartomas and ictal laughter: Evolution of a characteristic epileptic syndrome and diagnostic value of magnetic resonance imagingAnnals of Neurology, 1988