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. 2021 Nov;62(11):2697-2706. doi: 10.1111/epi.17071. Epub 2021 Sep 20.
To investigate long-term seizure outcomes in patients with hypothalamic hamartoma (HH) following stereotactic radiofrequency thermocoagulation (SRT).
A total of 131 patients with HH who underwent SRT and were followed for at least three years after the last SRT were enrolled. Seizure outcomes were evaluated for gelastic seizures (GS) and other types of seizures (nGS) separately using the International League Against Epilepsy classification. Classes 1 and 2 were considered seizure-free. Kaplan-Meier survival analyses were used to estimate the proportion remaining seizure-free after the first and last SRTs. Risk factors relating to outcomes were analyzed by log-rank tests and a multivariate Cox proportional hazards model.
Reoperation was performed in 34 patients (26.2%). Median total follow-up was 61 (range, 36-202) months. Seizure freedom was obtained in 116 patients (88.6%) for GS and 85 of 108 patients (78.7%) for nGS at the last follow-up. Mean GS-free survival times improved from after the first (64.1 [95%CI 57.3-70.9] months) to after the last SRT (80.2 [95%CI 75.7-84.8] months). About 90% of GS recurrences after the first SRT were found within 6 months, though a few patients recurred more than 2 years after the first SRT. On the other hand, mean nGS-free survival times after the first and last SRTs were not different between after the first SRT (84.4 [95%CI 73.0-90.7] months) and after the last SRT (83.1 [95%CI 74.1-92.0] months). There was no factor related to GS outcomes, but the significant factor for nGS-free survival after the last SRT was multiple previous treatments (p=0.01, hazard ratio=15.65, 95%CI 1.79-137.16).
The last SRT was almost equivalent to achieving complete disconnection of HHs from the hypothalamus according to our strategy. Considering the epileptogenic network, GS outcomes depend on complete disconnection, whereas nGS outcomes are not affected by surgical factors but independency of secondary epileptogenesis.
探讨立体定向射频热凝术（SRT）治疗下丘脑错构瘤（HH）患者的长期癫痫发作结局。
共纳入131例行SRT且在最后一次SRT后至少随访3年的HH患者。采用国际抗癫痫联盟分类法分别评估痴笑性癫痫（GS）和其他类型癫痫（nGS）的发作结局。1级和2级视为无癫痫发作。采用Kaplan-Meier生存分析估计首次和最后一次SRT后无癫痫发作的比例。通过对数秩检验和多变量Cox比例风险模型分析与结局相关的危险因素。
34例患者（26.2%）接受了再次手术。总中位随访时间为61（范围36 - 202）个月。在最后一次随访时，116例GS患者（88.6%）和108例nGS患者中的85例（78.7%）实现了无癫痫发作。GS无发作生存时间均值从首次SRT后（64.1[95%CI 57.3 - 70.9]个月）提高到最后一次SRT后（80.2[95%CI 75.7 - 84.8]个月）。首次SRT后约90%的GS复发在6个月内出现，不过少数患者在首次SRT后2年以上复发。另一方面，首次和最后一次SRT后nGS无发作生存时间均值在首次SRT后（84.4[95%CI 73.0 - 90.7]个月）和最后一次SRT后（83.1[95%CI 74.1 - 92.0]个月）无差异。与GS结局无关，但最后一次SRT后nGS无发作生存的显著相关因素是既往多次治疗（p = 0.01，风险比 = 15.65，95%CI 1.79 - 137.16）。
根据我们的策略，最后一次SRT几乎等同于实现HH与下丘脑的完全分离。考虑到癫痫发生网络，GS结局取决于完全分离，而nGS结局不受手术因素影响，而是取决于继发性癫痫发生的独立性。
