Schulze-Bonhage Andreas, Ostertag Christoph
Epilepsy Centre, University Hospital Freiburg, Freiburg, Germany.
Semin Pediatr Neurol. 2007 Jun;14(2):80-7. doi: 10.1016/j.spen.2007.03.006.
Surgical treatment of hypothalamic hamartomas (HHs) as the underlying etiology of gelastic epilepsy is associated with a high risk of complications because of the close vicinity of adjacent structures such as the optic tracts and mammillary bodies. Treatment with interstitial radiosurgery uses stereotactically implanted (125)I seeds emitting gamma radiation from the center of the lesion, with a steep spatial gradient, over a period of about 3 weeks. This form of HH therapy offers particular advantages regarding the risk for major side effects. In a series of 15 children and adolescents treated in Freiburg, Germany, 53% of patients achieved significant improvement in seizure frequency (Engel class I or II outcome). Transient side effects were related to the development of local edema, resulting in headache and mental slowing. A persistent weight gain was noted in 3 patients, which was severe in 1 (20 kg). There were no other neurologic, neuropsychologic, or neuropsychiatric side effects, which compares favorably with most surgical series.
将下丘脑错构瘤（HHs）作为痴笑性癫痫的潜在病因进行手术治疗，由于其紧邻视束和乳头体等相邻结构，并发症风险很高。间质放射外科治疗是通过立体定向植入（125）I种子，从病灶中心发射伽马射线，在约3周的时间内形成陡峭的空间梯度。这种HH治疗形式在重大副作用风险方面具有特殊优势。在德国弗莱堡接受治疗的一系列15名儿童和青少年中，53%的患者癫痫发作频率有显著改善（恩格尔I级或II级结果）。短暂副作用与局部水肿的发展有关，导致头痛和精神迟钝。3名患者出现持续体重增加，其中1名严重（20千克）。没有其他神经、神经心理或神经精神方面的副作用，这与大多数手术系列相比具有优势。
