Staged Magnetic Resonance-Guided Laser Interstitial Thermal Therapy for Hypothalamic Hamartoma: Analysis of Ablation Volumes and Morphological Considerations
| Autor: | Nisha Gadgil, Kathryn M. Wagner, Angus Wilfong, Daniel J. Curry, Irfan Ali, Melissa A. LoPresti, I-Wen Pan, Sandi Lam |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
Male
congenital hereditary and neonatal diseases and abnormalities medicine.medical_specialty Adolescent Hamartoma medicine.medical_treatment Young Adult 03 medical and health sciences Epilepsy 0302 clinical medicine Laser Interstitial Thermal Therapy Hypothalamic hamartoma Seizures Gelastic seizure Image Processing Computer-Assisted medicine Humans Child Retrospective Studies medicine.diagnostic_test business.industry Infant Postoperative complication Magnetic resonance imaging Ablation medicine.disease Magnetic Resonance Imaging Tumor Burden Treatment Outcome Child Preschool 030220 oncology & carcinogenesis Female Surgery Epilepsies Partial Laser Therapy Neurology (clinical) Radiology medicine.symptom business Hypothalamic Diseases 030217 neurology & neurosurgery Follow-Up Studies |
| Zdroj: | Neurosurgery. 86:808-816 |
| ISSN: | 1524-4040 0148-396X |
| Popis: | Background Hypothalamic hamartomas (HH) are a challenging pathology that cause gelastic seizures. Magnetic Resonance Imaging-guided Laser Interstitial Thermal Therapy (MRgLITT) offers a safe and effective treatment for HHs via a minimally invasive technique. Objective To determine how clinical outcome correlates to residual tumor volume and surgical strategy by analyzing radiographic data and reconstructing volumetric imaging. Methods Clinical and radiographic information of 58 pediatric patients who underwent MRgLITT for HH with at least 6 mo of follow-up were retrospectively reviewed. MR imaging was volumetrically reconstructed to analyze the impact of hamartoma and ablation volumes on outcome. Primary outcome measure was freedom from gelastic seizures. Results Eighty-one percent of patients were completely free of gelastic seizures at last follow-up; of 22 patients with secondary nongelastic epilepsy, 15 were free of additional seizures. Postoperative complication rate was low. There was no significant difference in gelastic seizure outcome related to pre- or postoperative hamartoma size. Residual hamartoma percentage in those free of gelastic seizures was 43% compared to 71% in those with continued seizures (P = .021). Larger hamartomas required multiple ablations to achieve seizure freedom. Conclusion This large series of patients confirms the safety and efficacy of MRgLITT for pediatric HH and describes morphological considerations that predict success. Our data suggest that complete ablation of the lesion is not necessary, and that the focus should be on appropriate disconnection of the epileptogenic network. We have found that a staged approach to hamartoma ablation allows adequate disconnection of the hamartoma while mitigating risk to surrounding structures. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|