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Hypothalamic hamartomas: neuropathological features with and without prior gamma knife radiosurgery
John F Kerrigan1, Angela Parsons, Stephen G Rice
1Hypothalamic Hamartoma Program, Phoenix Children's Hospital, Phoenix, AZ 85013, USA. neuropub @ chw.edu
Stereotactic and Functional Neurosurgery
|December 5, 2012
Summary
Gamma Knife radiosurgery (GK) reduces cell density in hypothalamic hamartoma (HH) tissue, potentially decreasing neuronal excitation and contributing to seizure control. This study investigated neuropathological changes in HH patients treated with GK.
Area of Science:
- Neuropathology
- Neurosurgery
- Epilepsy Research
Background:
- The neuropathological effects of Gamma Knife radiosurgery (GK) on hypothalamic hamartoma (HH) remain largely uncharacterized.
- Hypothalamic hamartoma is associated with treatment-resistant epilepsy.
Purpose of the Study:
- To compare neuropathological features of surgically resected hypothalamic hamartoma tissue from patients with and without prior Gamma Knife radiosurgery.
- To investigate the potential impact of GK on cell density and neuronal networks in HH.
Main Methods:
- Stereology and immunohistochemistry were used to analyze cell counts and glial activation in HH tissue.
- Tissue from patients with and without GK treatment history was compared to age-matched normal hypothalamus controls.
- Neuropathological scoring was performed by a blinded expert.
Main Results:
- Gamma Knife radiosurgery was associated with significantly decreased total cell density in HH tissue (p < 0.02).
- A trend towards decreased neuron density was observed with increasing GK dose (p = 0.06).
- GK-treated tissue showed increased reactive gliosis, thickened capillary endothelium, and microglial activation.
Conclusions:
- Non-ablative doses of Gamma Knife radiosurgery reduce cell density in human hypothalamic hamartoma.
- Observed cell loss may modulate neuronal network excitability, potentially contributing to seizure reduction in HH patients.
