Yao Yuan, Wang Xiu, Hu Wenhan, Zhang Chao, Sang Lin, Zheng Zhong, Mo Jiajie, Liu Chang, Qiu Jiaji, Shao Xiaoqiu, Zhang Jianguo, Zhang Kai
Department of Neurosurgery, Beijing TianTan Hospital, Capital Medical University, Beijing 100070, China.
Beijing Neurosurgical Institute, Capital Medical University, Beijing 100070, China.
J Clin Med. 2022 Nov 6;11(21):6579. doi: 10.3390/jcm11216579.
Hypothalamic hamartoma (HH) is a rare lesion consisting of normal neurons and neuroglia arranged in an abnormal pattern which usually causes gelastic seizures (GS). Magnetic resonance-guided laser interstitial thermal therapy (MRgLITT) has been developed as a minimally invasive approach to treat HH and gradually become a first-line treatment. In total, this study enrolled 47 consecutive HH patients that underwent one round of ablation. Patients were followed for at least one year. Patients' medical records and surgical information were carefully reviewed, and univariate analyses were performed. Of the treated patients, 72.3% remained GS-free in this study, with an overall Engel class I rate of 68.1%. Long-term postoperative complications occurred in six patients. Factors associated with GS prognosis included Delalande classification ( = 0.033), HH volume ( = 0.01), and the ablation rate of the HH body ( = 0.035). The disconnection rate was 0.73 ± 0.14 in the Engel class Ia group as compared to 0.62 ± 0.13 in the Engel Ib-Engel IV group ( = 0.046). MRgLITT represents a safe and effective surgical procedure. Patients with larger or Delalande type IV HH may require multiple rounds of ablation. In addition to assessing the degree of disconnection, ablation volume should also be carefully considered for patients undergoing this procedure.
下丘脑错构瘤（HH）是一种罕见的病变，由排列异常的正常神经元和神经胶质组成，通常会导致痴笑性癫痫（GS）。磁共振引导激光间质热疗（MRgLITT）已被开发为一种治疗HH的微创方法，并逐渐成为一线治疗方法。本研究共纳入47例连续接受一轮消融治疗的HH患者。对患者进行了至少一年的随访。仔细查阅了患者的病历和手术信息，并进行了单因素分析。在本研究中，72.3%的治疗患者无GS发作，总体Engel I级率为68.1%。6例患者出现长期术后并发症。与GS预后相关的因素包括Delalande分类（=0.033）、HH体积（=0.01）和HH体的消融率（=0.035）。Engel Ia组的分离率为0.73±0.14，而Engel Ib - Engel IV组为0.62±0.13（=0.046）。MRgLITT是一种安全有效的手术方法。较大或Delalande IV型HH的患者可能需要多轮消融。除了评估分离程度外，对于接受该手术的患者，还应仔细考虑消融体积。
