J Korean Neurosurg Soc.  2017 May;60(3):294-300. 10.3340/jkns.2017.0101.005.

Endoscopic Treatment of Hypothalamic Hamartomas

• Shim KW
• Park EK
• Kim DS

• KMID: 2382763
• DOI: http://doi.org/10.3340/jkns.2017.0101.005

Abstract

Hypothalamic hamartoma (HH) is a benign indolent lesion despite the presentation of refractory epilepsy. Behavioral disturbances and endocrine problems are additional critical symptoms that arise along with HHs. Due to its nature of generating epileptiform discharge and spreading to cortical region, various management strategies have been proposed and combined. Surgical approaches with open craniotomy or endoscopy, stereotactic approaches with radiosurgery and gamma knife surgery or radiofrequency thermos-coagulation, and laser ablation have been introduced. Topographical dimension and the surgeon's preference are key factors for treatment modalities. Endoscopic disconnection has been one of the most favorable options performed in treating HHs. Here we discuss presurgical evaluation, patient selection, surgical procedures, and complications.

Keyword

Hypothalamic hamartoma; Epilepsy; Endoscope

MeSH Terms

Craniotomy
Endoscopes
Endoscopy
Epilepsy
Hamartoma*
Laser Therapy
Patient Selection
Radiosurgery

Figure

• 

  Fig. 1 Classification and possible treatment selection for hypothalamic hamartoma (HH) (modification from Choi et al.8) and Delalande and Fohlen10)). The HHs are divided into four categories based on MR imaging findings, demonstrating the relationship between the hamartoma and hypothalamus or the third ventricle. A large hamartoma (>20 mm) is defined as a giant HH (Type IV). Small HHs (<20 mm) are classified as midline (Type I), lateral (Type II), and intraventricular (Type III) according to their location relative to the third ventricle. MR: magnetic resonance.

• 

  Fig. 2 Endoscopic approach to hypothalamic hamartoma (HHs). A: The trajectory to HH through Kocher’s point. B: The direction of dissection around the lateral border of HHs. C: Relatively small ventricle and foramen of Monro. D: Discrete appearance of HHs to show the interface between HHs and the hypothalamus. E: The first step of disconnection with monopolar coagulator along the lateral border of HHs. F: Disconnection of HHs from the hypothalamus with a monopolar coagulator. LV: lateral ventricle, OC: optic chiasm, HH: hypothalamic hamartoma, HY: hypothalamus.

Reference

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