Surgical treatment of hypothalamic hamartoma

ABSTRACT

Hypothalamic hamartomas are often associated with early onset gelastic seizures, precocious puberty, behavioral problem and suboptimal response to antiepiletptic drugs. Until now, four surgical options have been reported to reduce seizure by >50%. Surgical excision have good seizure outcome but postoperative complications were not infrequent, whether by pterional or transcallosal interforniceal approach. Radiosurgery is noninvasive alternative to resective surgery but the effect usually does not appear until several months later. Radiofrequency ablation is less invasive than surgical resection and its effect is immediate, but lacks long term follow-up data. It also requires three dimensional analysis of the lesion to enhance effi cacy and safety. As hypothalamic hamartoma is intrinsically epileptogenic and epileptogenic discharges spread from the lesion, blocking the seizure propagation through endoscopic disconnection is regarded as an effective and safer option. Surgical choice for a particular patient should take into account the hamartoma’s size, location, surgeon’s preferences, possible complication as well as the effect and risk of the various surgical methods. In the present review, open surgery, endoscopic disconnection, radiosurgery and radiofrequency ablation are discussed.