PMID- 27690651
OWN - NLM
STAT- MEDLINE
DCOM- 20170228
LR  - 20171116
IS  - 1092-0684 (Electronic)
IS  - 1092-0684 (Linking)
VI  - 41
IP  - 4
DP  - 2016 Oct
TI  - Magnetic resonance imaging-guided laser interstitial thermal therapy for 
      previously treated hypothalamic hamartomas.
PG  - E8
AB  - OBJECTIVE Hypothalamic hamartomas (HHs) are associated with gelastic seizures and 
      the development of medically refractory epilepsy. Magnetic resonance 
      imaging-guided laser interstitial thermal therapy (MRg-LITT) is a minimally 
      invasive ablative treatment that may have applicability for these deep-seated 
      lesions. Here, the authors describe 3 patients with refractory HHs who they 
      treated with MRg-LITT. METHODS An institutional review board-approved prospective 
      database of patients undergoing Visualase MRg-LITT was retrospectively reviewed. 
      Demographic and historical medical data, including seizure and medication 
      histories, previous surgeries, procedural details, and surgical complications, 
      along with radiological interpretation of the HHs, were recorded. The primary 
      outcome was seizure freedom, and secondary outcomes included medication 
      reduction, seizure frequency, operative morbidity, and clinical outcome at the 
      latest follow-up. RESULTS All 3 patients in the multi-institutional database had 
      developed gelastic seizures related to HH at the ages of 7, 7, and 9 years. They 
      presented for further treatment at 25, 28, and 48 years of age, after previous 
      treatments with stereotactic radiosurgery in all cases and partial hamartoma 
      resection in one case. One ablation was complicated by a small tract hemorrhage, 
      which was stable on postoperative imaging. One patient developed hyponatremia and 
      experienced weight gain, which were respectively managed with fluid restriction 
      and counseling. At the most recent follow-up at a mean of 21 months (range 1-32 
      months), one patient was seizure free while another had meaningful seizure 
      reduction. Medication was reduced in one case. CONCLUSIONS Adults with gelastic 
      seizures despite previous treatments can undergo MRg-LITT with reasonable safety 
      and efficacy. This novel therapy may provide a minimally invasive alternative for 
      primary and recurrent HH as the technique is refined.
FAU - Burrows, Anthony M
AU  - Burrows AM
AD  - Departments of 1 Neurosurgery.
FAU - Marsh, W Richard
AU  - Marsh WR
AD  - Departments of 1 Neurosurgery.
FAU - Worrell, Gregory
AU  - Worrell G
AD  - Neurology, and.
FAU - Woodrum, David A
AU  - Woodrum DA
AD  - Radiology, Mayo Clinic, Rochester, Minnesota.
FAU - Pollock, Bruce E
AU  - Pollock BE
AD  - Departments of 1 Neurosurgery.
FAU - Gorny, Krzysztof R
AU  - Gorny KR
AD  - Radiology, Mayo Clinic, Rochester, Minnesota.
FAU - Felmlee, Joel P
AU  - Felmlee JP
AD  - Radiology, Mayo Clinic, Rochester, Minnesota.
FAU - Watson, Robert E
AU  - Watson RE
AD  - Radiology, Mayo Clinic, Rochester, Minnesota.
FAU - Kaufmann, Timothy J
AU  - Kaufmann TJ
AD  - Radiology, Mayo Clinic, Rochester, Minnesota.
FAU - Goerss, Steven
AU  - Goerss S
AD  - Departments of 1 Neurosurgery.
FAU - Van Gompel, Jamie J
AU  - Van Gompel JJ
AD  - Departments of 1 Neurosurgery.
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Neurosurg Focus
JT  - Neurosurgical focus
JID - 100896471
RN  - Hypothalamic hamartomas
SB  - IM
CIN - Neurosurg Focus. 2017 May;42(5):E18. PMID: 28463619
MH  - Adult
MH  - Hamartoma/*diagnostic imaging/*surgery
MH  - Humans
MH  - Hypothalamic Diseases/*diagnostic imaging/*surgery
MH  - Laser Therapy/*methods
MH  - *Magnetic Resonance Imaging
MH  - Male
MH  - Middle Aged
MH  - Treatment Outcome
OTO - NOTNLM
OT  - DWI = diffusion weighted imaging
OT  - HH = hypothalamic hamartoma
OT  - ILAE = International League Against Epilepsy
OT  - LITT
OT  - MPRAGE = magnetization-prepared rapid gradient echo
OT  - MRg-LITT = MRI-guided laser interstitial thermal therapy
OT  - SIADH = syndrome of inappropriate antidiuretic hormone secretion
OT  - SRS = stereotactic radiosurgery
OT  - epilepsy
OT  - gelastic seizures
OT  - hypothalamic hamartomas
OT  - laser interstitial thermal therapy
EDAT- 2016/10/04 06:00
MHDA- 2017/03/01 06:00
CRDT- 2016/10/04 06:00
PHST- 2016/10/04 06:00 [entrez]
PHST- 2016/10/04 06:00 [pubmed]
PHST- 2017/03/01 06:00 [medline]
AID - 10.3171/2016.7.FOCUS16218 [doi]
PST - ppublish
SO  - Neurosurg Focus. 2016 Oct;41(4):E8. doi: 10.3171/2016.7.FOCUS16218.