Gamma Knife surgery for hypothalamic hamartomas causing refractory epilepsy: preliminary results from a prospective...

Area of Science:

• Neurosurgery
• Epileptology
• Radiation Oncology

Background:

• Hypothalamic hamartomas (HHs) are congenital brain malformations.
• HHs frequently cause medically refractory epilepsy, significantly impacting patient quality of life.
• Conventional surgical interventions for HHs carry substantial risks of morbidity.

Purpose of the Study:

• To evaluate the efficacy and safety of Gamma Knife radiosurgery for treating epilepsy associated with hypothalamic hamartomas.
• To compare outcomes between complete lesion ablation and radiosurgical disconnection techniques.

Main Methods:

• A prospective observational study included nine patients with HHs and refractory epilepsy.
• Patients underwent Gamma Knife radiosurgery, with treatment strategy tailored to hamartoma size (complete ablation vs. disconnection).
• Seizure status (Engel Classification), quality of life, and neuropsychological function were assessed post-treatment.

Main Results:

• Complete ablation of smaller HHs (Grade I-III) resulted in seizure freedom (Engel Class I) or rare seizures (Engel Class II) in 5 out of 6 patients.
• Radiosurgical disconnection for larger HHs (Grade IV-VI) did not improve epilepsy (Engel Class IV).
• Improved quality of life and verbal memory were observed in patients with over 3 years of follow-up; no adverse events were reported.

Conclusions:

• Gamma Knife radiosurgery is a safe and effective treatment for epilepsy secondary to HHs when the entire lesion can be targeted.
• Radiosurgical disconnection is not recommended due to its ineffectiveness in controlling seizures associated with larger HHs.