Shirozu Hiroshi, Masuda Hiroshi, Kameyama Shigeki
Department of Functional Neurosurgery National Hospital Organization Nishiniigata Chuo Hospital Niigata Japan.
Hypothalamic Hamartoma Center National Hospital Organization Nishiniigata Chuo Hospital Niigata Japan.
Epilepsia Open. 2020 Jan 18;5(1):107-120. doi: 10.1002/epi4.12378. eCollection 2020 Mar.
To evaluate the feasibility of repeat stereotactic radiofrequency thermocoagulation (re-SRT) for patients with hypothalamic hamartoma (HH) and to clarify clinical and surgical factors for seizure outcomes.
Hypothalamic hamartoma patients with gelastic seizures (GSs) who underwent SRT were retrospectively reviewed. Seizure outcomes were evaluated separately for GS and other types of seizures (non-GS). Surgical complications were compared between re-SRT and first SRT. Clinical and surgical factors related to both seizure recurrences after first SRT and final seizure outcomes were analyzed.
Participants comprised 150 patients (92 males; median age at surgery, 8 years; range, 1.7-50 years). Of those, 122 (81.3%) had non-GS. Forty-three patients (28.7%) underwent re-SRT. Freedom from GS was achieved by first SRT in 103 patients (68.7%), second SRT in 30/40 (67.5%), third SRT in 3/10 (30.0%), and fourth SRT in 2/3 (66.7%). Finally, 135 patients (90.0%) became GS-free. Ninety patients (73.8%) achieved non-GS freedom, with first SRT in all except one case. Transient complications were more frequent with first SRT (118/150, 78.7%) than re-SRT (35/56, 62.5%), whereas persistent complications were more frequent with re-SRT (7/56, 12.5%) than with first SRT (3/150, 2.0%). Multivariate analyses revealed only younger age at surgery (≤1 year) as related to GS recurrence after first SRT, with no variables affecting final GS outcomes. Meanwhile, seizure type (tonic seizure), intellectual disability, and genetic syndromes were significant factors for both non-GS recurrence and final outcomes. Multiple previous treatments were significantly related to final non-GS outcomes as well. Size and subtype of HH and surgical factors were unrelated to seizure outcomes.
Repeat stereotactic radiofrequency thermocoagulation provides potential opportunities to achieve freedom from recurrent GS, albeit with increased risks of persistent complications. Non-GS and intellectual disability could offer early surgical indications, and repeated ineffective treatments should be avoided.
评估重复立体定向射频热凝术（re-SRT）用于下丘脑错构瘤（HH）患者的可行性，并阐明影响癫痫发作结果的临床和手术因素。
对接受SRT治疗的伴有痴笑性癫痫（GS）的下丘脑错构瘤患者进行回顾性研究。分别评估GS和其他类型癫痫（非GS）的发作结果。比较re-SRT和首次SRT的手术并发症。分析与首次SRT后癫痫复发及最终发作结果相关的临床和手术因素。
研究对象包括150例患者（92例男性；手术时的中位年龄为8岁；范围为1.7 - 50岁）。其中，122例（81.3%）患有非GS。43例患者（28.7%）接受了re-SRT。首次SRT使103例患者（68.7%）摆脱GS，第二次SRT使40例中的30例（67.5%）摆脱，第三次SRT使10例中的3例（30.0%）摆脱，第四次SRT使3例中的2例（66.7%）摆脱。最终，135例患者（90.0%）摆脱了GS。90例患者（73.8%）实现了非GS缓解，除1例外均通过首次SRT实现。首次SRT的短暂并发症（118/150，78.7%）比re-SRT（35/56，62.5%）更常见，而re-SRT的持续性并发症（7/56，12.5%）比首次SRT（3/150，2.0%）更常见。多因素分析显示，仅手术时年龄较小（≤1岁）与首次SRT后GS复发有关，且无变量影响最终GS结果。同时，癫痫发作类型（强直发作）、智力残疾和遗传综合征是非GS复发及最终结果的重要因素。既往多次治疗也与最终非GS结果显著相关。HH的大小和亚型以及手术因素与发作结果无关。
重复立体定向射频热凝术为实现摆脱复发性GS提供了潜在机会，尽管持续性并发症风险增加。非GS和智力残疾可提供早期手术指征，应避免重复无效治疗。
