Magnetic Resonance Imaging-Guided Laser Interstitial Thermal Therapy for the Treatment of Hypothalamic Hamartomas: A Retrospective Review.
BACKGROUND: 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.
OBJECTIVE: To evaluate a single center's outcomes for the LITT treatment of HH.
METHODS: We retrospectively reviewed our experience with LITT for the treatment of HH using our institution's prospectively maintained patient database.
RESULTS: 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).
CONCLUSION: 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.
Medical Subject Headings
Adolescent; Adult; Aged; Child; Child, Preschool; Female; Hamartoma; Humans; Hypothalamic Diseases; Laser Therapy; Magnetic Resonance Imaging; Male; Middle Aged; Postoperative Complications; Retrospective Studies; Seizures; Surgery, Computer-Assisted; Treatment Outcome; Young Adult
Digital Object Identifier (DOI)
Xu, David S; Chen, Tsinsue; Hlubek, Randall J; Bristol, Ruth E; Smith, Kris A; Ponce, Francisco A; Kerrigan, John F; and Nakaji, Peter, "Magnetic Resonance Imaging-Guided Laser Interstitial Thermal Therapy for the Treatment of Hypothalamic Hamartomas: A Retrospective Review." (2018). Neurosurgery. 757.