[Surgical disconnection of hypothalamic hamartomas]

Area of Science:

• Neurosurgery
• Epileptology
• Neurology

Context:

• Hypothalamic hamartomas (HHs) are associated with intractable gelastic epilepsy.
• Surgical resection of HHs carries significant risks of neurological and endocrine complications.
• Minimally invasive surgical techniques are sought for broadly attached or third ventricular lesions.

Purpose:

• To evaluate the efficacy and safety of disconnective surgical techniques for HHs.
• To compare pterional and frameless stereotactic endoscopic approaches for HH disconnection.
• To assess seizure outcomes and morbidity based on HH location and surgical method.

Summary:

• Forty-three patients with HHs underwent disconnection surgery between 1998 and 2005.
• A pterional approach was used for downward-extending lesions, while endoscopic techniques were employed for third ventricular HHs.
• Fifty percent of patients became seizure-free, with significant reduction in 40% and minimal morbidity, especially with the endoscopic approach.

Impact:

• Disconnection procedures are a viable alternative to resection for epilepsy-related HHs.
• Endoscopic disconnection offers acceptable morbidity and good seizure control, particularly for intraventricular HHs.
• This study supports tailored surgical approaches based on HH classification for improved patient outcomes.