Surgical treatment of hypothalamic hamartomas

Autor: Olivier Bekaert, M. Fohlen, Mathilde Chipaux, S. Ferrand-Sorbet, Caroline Apra, Christine Bulteau, S. Rosenberg, Georg Dorfmüller, Pierre Bourdillon, Vera Dinkelacker, C. Le Guérinel, N. Dorison, E. Raffo
Přispěvatelé: Institut du Cerveau = Paris Brain Institute (ICM), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU)-Sorbonne Université (SU)-Centre National de la Recherche Scientifique (CNRS), Hôpital Rothschild [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Service de neurochirurgie pédiatrique [CHU Necker], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Necker - Enfants Malades [AP-HP], Thales Research and Technologies [Orsay] (TRT), THALES [France], Service de Génétique Clinique Pédiatrique [CHRU Nancy], Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Gestionnaire, HAL Sorbonne Université 5, Institut du Cerveau et de la Moëlle Epinière = Brain and Spine Institute (ICM), Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Pitié-Salpêtrière [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Centre National de la Recherche Scientifique (CNRS), THALES
Jazyk: angličtina
Rok vydání: 2021
Předmět:
Male
medicine.medical_specialty
Drug Resistant Epilepsy
medicine.medical_treatment
Hamartoma
disconnection
Radiosurgery
Neurosurgical Procedures
030218 nuclear medicine & medical imaging
Cerebral Ventricles
LiTT
03 medical and health sciences
Epilepsy
0302 clinical medicine
Radiofrequency thermocoagulation
Imaging
Three-Dimensional
radiofrequency
Hypothalamic hamartoma
Seizures
Gelastic seizure
medicine
Humans
[SDV.NEU] Life Sciences [q-bio]/Neurons and Cognition [q-bio.NC]
coagulation
gelastic
business.industry
General Medicine
Microsurgery
medicine.disease
Magnetic Resonance Imaging
3. Good health
Surgery
laser
stereotactic
Treatment Outcome
Neuroendoscopy
epilepsy
Female
[SDV.NEU]Life Sciences [q-bio]/Neurons and Cognition [q-bio.NC]
Neurology (clinical)
Neurosurgery
medicine.symptom
business
030217 neurology & neurosurgery
Hypothalamic Diseases
Zdroj: Neurosurgical Review
Neurosurgical Review, 2021, 44 (2), pp.753-762. ⟨10.1007/s10143-020-01298-z⟩
Neurosurgical Review, Springer Verlag, 2021, 44 (2), pp.753-762. ⟨10.1007/s10143-020-01298-z⟩
ISSN: 0344-5607
1437-2320
DOI: 10.1007/s10143-020-01298-z⟩
Popis: Hypothalamic hamartomas are aberrant masses, composed of abnormally distributed neurons and glia. Along endocrine and cognitive symptoms, they may cause epileptic seizures, including the specific gelastic and dacrystic seizures. Surgery is the treatment of drug-resistant hamartoma epilepsy, with associated positive results on endocrine, psychiatric, and cognitive symptoms. Recently, alternatives to open microsurgical treatment have been proposed. We review these techniques and compare their efficacy and safety. Open resection or disconnection of the hamartoma, either through pterional, transcallosal, or transventricular approach, leads to good epileptological control, but its high complication rate, up to 30%, limits its indications. The purely cisternal peduncular forms remain the only indication of open, pterional approach, while other strategies have been developed to overcome the neurological, endocrine, behavioral, or cognitive complications. Laser and radiofrequency thermocoagulation-based disconnection through robot-guided stereo-endoscopy has been proposed as an alternative to open microsurgical resection and stereotactic destruction. The goal is to allow safe and complete disconnection of a possibly complex attachment zone, through a single intraparenchymal trajectory which allows multiple laser or radiofrequency probe trajectory inside the ventricle. The efficacy was high, with 78% of favorable outcome, and the overall complication rate was 8%. It was especially effective in patients with isolated gelastic seizures and pure intraventricular hamartomas. Stereotactic radiosurgery has proved as efficacious and safer than open microsurgery, with around 60% of seizure control and a very low complication rate. Multiple stereotactic thermocoagulation showed very interesting results with 71% of seizure freedom and 2% of permanent complications. Stereotactic laser interstitial thermotherapy (LiTT) seems as effective as open microsurgery (from 76 to 81% of seizure freedom) but causes up to 20% of permanent complications. This technique has however been highly improved by targeting only the epileptogenic onset zone in the hamartoma, as shown on preoperative functional MRI, leading to an improvement of epilepsy control by 45% (92% of seizure freedom) with no postoperative morbidity. All these results suggest that the impact of the surgical procedure does not depend on purely technical matters (laser vs radiofrequency thermocoagulation or stereotactic vs robot-guided stereo-endoscopy) but relies on the understanding of the epileptic network, including inside the hamartoma, the aim being to plan an effective disconnection or lesion of the epileptogenic part while sparing the adjacent functional structures.
Databáze: OpenAIRE
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