Magnetic resonance imaging-guided laser interstitial thermal therapy for previously treated hypothalamic hamartomas

Anthony M. Burrows, W. Richard Marsh, Gregory Alan Worrell, David A Woodrum, Bruce E. Pollock, Krzysztof R. Gorny, Joel P. Felmlee, Robert E. Watson, Timothy J Kaufmann, Steven Goerss, Jamie Van Gompel

Research output: Contribution to journalArticle

17 Scopus citations

Abstract

Objective Hypothalamic hamartomas (HHs) are associated with gelastic seizures and the development of medically refractory epilepsy. Magnetic resonance imaging-guided laser interstitial thermal therapy (MRg-LITT) is a minimally invasive ablative treatment that may have applicability for these deep-seated lesions. Here, the authors describe 3 patients with refractory HHs who they treated with MRg-LITT. Methods An institutional review board-approved prospective database of patients undergoing Visualase MRg-LITT was retrospectively reviewed. Demographic and historical medical data, including seizure and medication histories, previous surgeries, procedural details, and surgical complications, along with radiological interpretation of the HHs, were recorded. The primary outcome was seizure freedom, and secondary outcomes included medication reduction, seizure frequency, operative morbidity, and clinical outcome at the latest follow-up. Results All 3 patients in the multi-institutional database had developed gelastic seizures related to HH at the ages of 7, 7, and 9 years. They presented for further treatment at 25, 28, and 48 years of age, after previous treatments with stereotactic radiosurgery in all cases and partial hamartoma resection in one case. One ablation was complicated by a small tract hemorrhage, which was stable on postoperative imaging. One patient developed hyponatremia and experienced weight gain, which were respectively managed with fluid restriction and counseling. At the most recent follow-up at a mean of 21 months (range 1-32 months), one patient was seizure free while another had meaningful seizure reduction. Medication was reduced in one case. Conc lusions Adults with gelastic seizures despite previous treatments can undergo MRg-LITT with reasonable safety and efficacy. This novel therapy may provide a minimally invasive alternative for primary and recurrent HH as the technique is refined.

Original languageEnglish (US)
Article numberE8
JournalNeurosurgical Focus
Volume41
Issue number4
DOIs
StatePublished - 2016

Keywords

  • Epilepsy
  • Gelastic seizures
  • Hypothalamic hamartomas
  • Laser interstitial thermal therapy
  • LITT

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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