Surgical Results of Mri-guided Stereotactic Radiofrequency Thermocoagulation in 263 Patients with Hypothalamic Hamartoma
Abstract number :
2.462
Submission category :
9. Surgery / 9C. All Ages
Year :
2024
Submission ID :
1253
Source :
www.aesnet.org
Presentation date :
12/8/2024 12:00:00 AM
Published date :
Authors :
Presenting Author: Hiroshi Shirozu, MD, PhD – NHO Nishiniigata Chuo Hospital
Hiroshi Masuda, M.D., Ph.D. – NHO Nishiniigata Chuo Hospital
Shigeki Kameyama, MD, PhD – Niigata Seiro Hospital
Rationale: Although stereotactic laser ablation surgery has been emerging a first-line option of surgical treatment for hypothalamic hamartomas (HHs), stereotactic radiofrequency thermocoagulation (SRFTC) is still useful option especially in the region where laser ablation is unavailable. The present study aims to evaluate the surgical results of MRI-guided stereotactic radiofrequency thermocoagulation (MRgSRFTC) for HH.
Methods: 263 patients with HH had undergone MRgSRFTC for drug-resistant gelastic seizure (GS) from 1997 to April 2024. We investigated clinical findings for all patients and seizure outcomes for patients with at least 1-year follow-up after the last surgery.
Results: 163 patients (62.0%) were male. 212 patients (80.6%) had other types of seizure (nonGS). Age at surgery ranged from 1.5 to 51 years old (median, 7.3), age at GS onset 0–12 (0.7), and age at nonGS onset 0–44 (4). Duration of GS was 0.4–47 years (5.65), and nonGS 0–45 (3.2). Maximum diameter of HH was from 4.5 to 80 mm (15). HH subtypes were classified into parahypothalmic-type (23, 8.7%), intrahypothalamic-type (77, 29.3%), and mixed-type (163, 62.0%). Bilateral attachments were observed in 152 patients (57.8%). Behavioral disorders (n=147, 56.1%) and intellectual disability (n=136, 52.3%) were also found. 53 patients (20.2%) had previous failed treatments. A total of 338 MRgSRFTCs including repeat MRgSRFTC in 60 patients (22.8%) were performed. 237 patients (90.1%) were able to be evaluated their seizure outcomes. After their final surgery, freedom from GS was achieved in 214 patients (91.1%) In contrast, nonGS freedom was obtained in 150/188 (79.8%).
Conclusions: MRgSRFTC was effective for epilepsy due to HH regardless of HH morphology and even for those with previous failed treatment. Repeat MRgSRFTC was also effective for recurrent GSs. An early indication of stereotactic ablation surgery is recommended.
Funding: This study is partially supported by the MHLW Research program on rare and intractable diseases (grant number: JPMH23FC1013)
Surgery