Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona.
Department of Neurosurgery, Barrow Neurological Institute, Phoenix Children's Hospital, Phoenix, Arizona.
Neurosurgery. 2018 Dec 1;83(6):1183-1192. doi: 10.1093/neuros/nyx604.
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.
To evaluate a single center's outcomes for the LITT treatment of HH.
We retrospectively reviewed our experience with LITT for the treatment of HH using our institution's prospectively maintained patient database.
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).
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.
下丘脑错构瘤（HH）是一种罕见的病变，与治疗抵抗性癫痫有关。开颅手术的癫痫控制效果适中（约 50%），但有显著的相关发病率。由于潜在的治疗效果，放射外科仅限于一部分患者。磁共振成像引导激光间质热疗（LITT）提供了一种新的微创选择。
评估单一中心 LITT 治疗 HH 的结果。
我们回顾性地审查了我们使用机构前瞻性维护的患者数据库，对 LITT 治疗 HH 的经验。
18 例患者（平均年龄 21.1 岁；中位数年龄 11 岁）接受了 21 次 HH 全 LITT 治疗。平均随访时间为 17.4 个月。16 例（89%）患者的住院时间为 1 晚。在随访结束时，18 例患者中有 11 例（61%）HH 完全断开，12 例（80%）有发笑性发作的患者和 5 例（56%）无发笑性发作的患者无癫痫发作（国际抗癫痫联盟分级 1）。即刻并发症包括神经功能缺损发生率为 39%（7/18），包括 1 例偏瘫。在随访结束时，22%的患者（4/18）有持续的缺陷。发生的甲状腺功能减退延迟了 11%的患者（2/18），还有短期记忆丧失（22%，4/18）和体重增加（22%，4/18）。
LITT 治疗 HH 可以在大多数患者中实现极好的癫痫控制率，发病率低，术后住院时间短。需要进一步研究来评估结果的持久性和认知结果的全貌。
