Department of Functional Neurosurgery, National Hospital Organization Nishiniigata Chuo Hospital, Niigata, Japan.
Hypothalamic Hamartoma Center, National Hospital Organization Nishiniigata Chuo Hospital, Niigata, Japan.
Epilepsia. 2020 Dec;61(12):2739-2747. doi: 10.1111/epi.16730. Epub 2020 Oct 21.
Ablation surgery has become the first line of treatment for hypothalamic hamartomas (HHs). For effective treatment, optimum targeting of ablation is mandatory. The present study aimed to evaluate the correspondence between the electrophysiological features of HHs and morphological targeting by semimicrorecording during stereotactic radiofrequency thermocoagulation (SRT).
Eighty HH patients who underwent SRT were involved. Semimicrorecording was performed on the first trajectory. The distance from the center of the target at the morphological border (TMB) determined by magnetic resonance imaging, differences in discharge patterns, and area potentials (APs) were measured.
The electrophysiological border (EB) between the HH and hypothalamus was detected by semimicrorecording in 73 (91.3%), AP increase (API) in the HH was detected in 31 (38.8%), and spike discharges (SDs) of the HH were detected in 56 patients (70.0%). Semimicrorecording showed significantly different APs among structures passing through the trajectory, except between API and SDs. The median distances from the center of the TMB to the EB, API, SDs, and AP decline were -3.50, -2.49, -1.38, and +2.00 mm, respectively.
The electrophysiological features of HHs were shown by semimicrorecording during SRT. The EB corresponded to the morphological border. The electrophysiologically active area of HHs was located near the border. Ablation surgery should focus on disconnection at the border between the HH and the hypothalamus to maximize its effectiveness, as well as to reduce complications.
对于下丘脑错构瘤（HHs），消融手术已成为首选治疗方法。为了实现有效治疗，必须进行最佳的消融靶点定位。本研究旨在评估立体定向射频热凝术（SRT）期间半微电极记录的 HH 电生理特征与形态学靶点之间的相关性。
纳入 80 例接受 SRT 的 HH 患者。在第一条轨迹上进行半微电极记录。测量距磁共振成像（MRI）确定的目标形态边界（TMB）中心的距离、放电模式差异和区域电位（AP）。
通过半微电极记录在 73 例（91.3%）患者中检测到 HH 与下丘脑之间的电生理边界（EB），在 31 例（38.8%）患者中检测到 HH 中的 AP 增加（API），在 56 例患者（70.0%）中检测到 HH 的棘波放电（SD）。除 API 和 SD 之间外，半微电极记录显示穿过轨迹的结构之间的 AP 明显不同。TMB 中心到 EB、API、SD 和 AP 下降的中心的中位数距离分别为-3.50、-2.49、-1.38 和+2.00mm。
SRT 期间通过半微电极记录显示了 HH 的电生理特征。EB 对应于形态边界。HH 的电生理活性区域位于边界附近。消融手术应集中在 HH 与下丘脑之间的边界上进行去连接，以最大限度地提高其有效性，并减少并发症。
