Rationale:
We had published some studies on large cohort of hypothalamic hamartomas (HHs) treated by stereotactic radiofrequency thermocoagulation (SRFTC). In past, SRFTC was performed by using Leksell frame with manual manipulation, and then, now robot (ROSA)-assisted system has been introduced for our SRFTC. The present study aims to evaluate the safety, convenience, and results of robot-assisted SRFTC for the treatment of HHs.
Methods:
Robot-assisted SRFTC was performed by using ROSA one® with confirmation by O-arm. Registration to ROSA was made by O-arm with 5-points of bone fiducials. Radiofrequency thermocoagulation was performed with 2-mm diameter of rigid lesioning probe (2x4 mm active tip) and RF-generator (Top, Tokyo, Japan). Surgical strategy was identical to the previous strategy, which is consisted of a combination of multiple trajectories and coagulations to disconnect HH from the hypothalamus at the border between HH and the hypothalamus.
Results:
Two patients underwent robot-assisted SRFTC. Case 1 was 5-years-old girl presenting daily gelastic seizures (GSs) and focal preserved consciousness seizure (eye and head turn). Her HH was intrahypothalamic-bilateral type with the maximum diameter was 14 mm. SRFTC was performed with five trajectories and nine coagulations, which were accompanied without any complications except for slight increase of appetite. She became seizure free after surgery. Case 2 was 3-years-old boy with frequent GSs and epileptic spasms. He also showed moderate developmental delay and behavioral problem (hyperactivity). His HH was mixed-bilateral type with the maximum diameter of 18 mm. SRFTC was performed with eight trajectories and 14 coagulations, which were accompanied without complications except for transient complications including mild hyponatremia and slight increase of appetite. He showed not only overall seizure freedom but also after surgery. Both surgeries were achieved complete disconnection without any troubles.
Conclusions:
Robot-assisted SRFTC supported by O-arm provides a seamless procedure compared classical manual-manipulated SRFTC. The accuracy was almost same as the classical procedure, resulted in almost same effectiveness as that by classical procedure.
Funding: None