Subscribe to RSS
DOI: 10.1055/s-2004-830267
Open Radiofrequency Ablation for the Management of Intractable Epilepsy Associated with Sessile Hypothalamic Hamartoma
Publication History
Publication Date:
13 July 2005 (online)
Abstract
Sessile hypothalamic hamartoma (HH) often causes intractable epilepsy, which is difficult to control even by microsurgical resection and gamma knife surgery (GKS), especially when the hamartoma is intrahypothalamic, large, or irregularly shaped. We successfully applied radiofrequency ablation (RFA) to reduce its epileptogenicity and to disconnect seizure propagation. The patient was a 26-year-old man who presented with refractory epilepsy and severe mental retardation from age 6 months. He had undergone three surgeries yielding partial resection and conventional irradiation treatments. The residual HH was thin and shaped like a bent plate, attached widely to the floor of the third ventricle. He underwent open RFA via the transcallosal subchoroidal approach under strict image guidance, which resulted in immediate and remarkable seizure remission without complications. This suggests that open RFA is a minimally invasive technique for an irregularly shaped HH that is difficult to treat by other modalities.
Key words
Hypothalamic hamartoma - intractable epilepsy - radiofrequency ablation
References
- 1 Fukuda M, Kameyama S, Wachi M, Tanaka R. Stereotaxy for hypothalamic hamartoma with intractable gelastic seizures: technical case report. Neurosurgery. 1999; 44 1347-1350
- 2 Arita K, Ikawa F, Kurisu K, Sumida M, Harada K, Uozumi T, Monden S, Yoshida J, Nishi Y. The relationship between magnetic resonance imaging findings and clinical manifestations of hypothalamic hamartoma. J Neurosurg. 1999; 91 212-220
- 3 Sisodiya S M, Free S L, Stevens J M, Fish D R, Shorvon S D. Widespread cerebral structural changes in two patients with gelastic seizures and hypothalamic hamartomata. Epilepsia. 1997; 38 1008-1010
- 4 Valdueza J M, Cristante L, Dammann O, Bentele K, Vortmeyer A, Saeger W, Padberg B, Freitag J, Herrmann H-D. Hypothalamic hamartomas: with special reference to gelastic epilepsy and surgery. Neurosurgery. 1994; 34 949-958
- 5 Nishio S, Shigeto H, Fukui M. Hypothalamic hamartoma: the role of surgery. Neurosurg Rev. 1993; 16 157-160
- 6 Rosenfeld J V, Harvey A S, Wrennall J, Zacharin M, Berkovic S F. Transcallosal resection of hypothalamic hamartomas, with control of seizures, in children with gelastic epilepsy. Neurosurgery. 2001; 48 108-118
- 7 Régis J, Bartolomei F, de Toffol B, Genton P, Kobayashi T, Mori Y, Takakura K, Hori T, Inoue H, Schröttner O, Pendl G, Wolf A, Arita K, Chauvel P. Gamma knife surgery for epilepsy related to hypothalamic hamartomas. Neurosurgery. 2000; 47 1343-1352
- 8 Régis J, Bartolomei F, Rey M, Hayashi M, Chauvel P, Peragut J C. Gamma knife surgery for mesial temporal lobe epilepsy. J Neurosurg. 2000; 93 (Suppl 3) 141-146
- 9 Fujimoto Y, Kato A, Saitoh Y, Ninomiya H, Imai K, Sakakibara R I, Maruno M, Kishima H, Yoshimura K, Hasegawa H, Yoshimine T. Stereotactic radiofrequency ablation for sessile hypothalamic hamartoma with an image fusion technique. Acta Neurochir. 2003; 145 697-701
- 10 Kato A, Yoshimine T, Hayakawa T, Tomita Y, Ikeda T, Mitomo M, Harada K, Mogami H. A frameless, armless navigational system for computer-assisted neurosurgery. Technical note. J Neurosurg. 1991; 74 845-849
- 11 Kato A, Yoshimine T, Taniguchi M, Hirata M, Fujinaka T, Hirabuki N, Okumura T, Hayakawa T. CANS Navigator for skull base surgery: Usefulness of Successive Localizations and Surgical Track. In: Tamaki N, K Ehara (eds). Computer-Assisted Neurosurgery. Tokyo: Springer Verlag 1997: 175-189
- 12 Delalande O, Fohlen M. Disconnecting surgical treatment of hypothalamic hamartoma in children and adults with refractory epilepsy and proposal of a new classification. Neurol Med Chir (Tokyo). 2003; 43 61-68
- 13 Kuzniecky R, Guthrie B, Mountz J, Bebin M, Faught E, Gilliam F, Liu H G. Intrinsic epileptogenesis of hypothalamic hamartoma in gelastic epilepsy. Ann Neural. 1997; 42 60-67
- 14 Parrent A G. Stereotactic radiofrequency ablation for the treatment of gelastic seizures associated with hypothalamic hamartoma. Case report. J Neurosurg. 1999; 91 881-884
- 15 Kandel E I, Watts G, Walker A E. Functional and Stereotactic Neurosurgery. New York and London, Plenum Medical Book Company 1989: 175-177
Amami Kato,M. D., Ph. D.
Department of Neurosurgery · Osaka University Medical School
2-2 Yamadaoka, Suita
Osaka 565-0871
Japan
Phone: +81-6-6879-3652
Fax: +81-6-6879-3659 ·
Email: akato@nsurg.med.osaka-u.ac.jp