Management of hypothalamic hamartomas: progress due to alignment of the stars Introduction
Harold L. Rekate, M.D., Neurosurg Focus 30(2) 2011 Journal of Neurosurgery
The evolution of treatment for hypothalamic hamartoma: a personal odyssey
Jeffrey V. Rosenfeld, M.D., M.S., F.R.A.C.S., Neurosurg Focus 30(2) E1 2011 Journal of Neurosurgery
ABSTRACT:The prognosis for patients with hypothalamic hamartoma has improved dramatically over the last 20 years, for 3 main reasons. First, because of improved understanding of the anatomy and pathophysiology of these varied lesions. Second, due to advances in brain imaging and refinements in microsurgery, including the anterior transcallosal interforniceal approach, endoscopic, and skull-base approaches. And third, because of increasing experience with stereotactic radiosurgery, interstitial radiotherapy, and radiofrequency lesioning. Patients with hypothalamic hamartoma should be managed in comprehensive epilepsy centers where the treatments are individualized and concentrated in the hands of surgeons who can perform the full range of surgery, including approaches to the third ventricle. Total seizure-freedom rates of 52% to 66% have been achieved with surgery.
Gelastic Seizures Associated with Hypothalamic Hamartomas
An Update in the Clinical Presentation, Diagnosis and Treatment, Tellez-Zenteno and others, Neuropsychiatric Disease and Treatment 2008, Vol 4(6) 1021-1031 © 2008 Dove Press
Surgical Management of Hypothalamic Hamartoma in Patients with Gelastic Epilepsy
Addas and others, Neurosurg. Focus 25(3) E8 2008 © 2008 Journal of Neurosurgery
ABSTRACT: Gelastic epilepsy (GE) associated with hypothalamic hamartomas (HHs) is now a well-characterized clinical syndrome consisting of gelastic seizures starting in infancy, medically refractory seizures with or without the development of multiple seizure types, and behavioral and cognitive decline. It has been postulated that the development of the HHGE syndrome is a result of a progressive epileptic encephalopathy or secondary epileptogenesis, which is potentially reversible with treatment of the HH. A variety of surgical options for the treatment of HHs exist, including open and endoscopic procedures, radiosurgery, interstitial radiotherapy, and stereotactic radiofrequency thermocoagulation. Surgical treatment can result in seizure freedom in up to 50% of patients and can be accompanied by significant improvements in behavior, cognition, and quality of life. Partial treatment of HHs may be sufficient to reduce seizure frequency and improve behavior and quality of life with less risk. A component of reversible cognitive dysfunction may be present in some patients with an HH-GE syndrome.
Introduction to [Hypothalamic Hamartomas]
John Kerrigan, Semin Pediatr Neurol 14:49-50 © 2007 Elsevier Inc