Seizure outcome and complications following hypothalamic hamartoma treatment in adults: endoscopic, open, and Gamma Knife procedures

Journal of Neurosurgery - Tập 117 Số 2 - Trang 255-261 - 2012
Cornelia Drees1, Kevin Chapman2, Erin Prenger3, Leslie C. Baxter4, Rama Maganti5,6, Harold L. Rekate7, Andrew G. Shetter8,9, Maggie Bobrowitz10, John Kerrigan11
1Department of Neurology, University of Colorado School of Medicine, Aurora, Colorado 80045, USA.
22Department of Pediatric Neurology, Colorado Children's Hospital, Denver, Colorado;
33Departments of Neuroradiology,
44Neuropsychology/Neuroimaging Lab,
55Neurology,
6Neurology,
76Department of Neurosurgery, Chiari Institute Long Island, Great Neck, New York
87Neurosurgery, and
9Neurosurgery, and
108Neuroscience, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona;
119Department of Pediatric Neurology, Phoenix Children's Hospital, Phoenix, Arizona; and

Tóm tắt

Object This study aimed at identifying outcomes with respect to seizures, morbidity, and mortality in adult patients undergoing resective or Gamma Knife surgery (GKS) to treat intractable epilepsy associated with hypothalamic hamartoma (HH). Methods Adult patients undergoing surgical treatment for HH-related epilepsy were prospectively monitored at a single center for complications and seizure outcome by using a proprietary database. Preintervention and postintervention data for patients 18 years of age and older, and with at least 1 year of follow-up, were analyzed, with specific attention to seizure control, complications, hormonal status, and death. Results Forty adult patients were found in the database (21 were women). The median HH volume was 0.54 cm3. In 70% of patients, it was located inside the third ventricle, attached unilaterally and vertically to the hypothalamus (Delalande Type II). Most patients (26) underwent an endoscopic resection, 10 patients had a transcallosal or other type of open (pterional or orbitozygomatic) resection, and 4 patients chose GKS. Twenty-nine percent became seizure free in the long term, and overall a majority of patients (55%) reported at least > 90% seizure improvement. Only 3 patients were ultimately able to discontinue anticonvulsants, whereas most patients were taking an average of 2 antiepileptic drugs pre- and postoperatively. The only factor significantly correlated with seizure-free outcome was the absence of mental retardation. The HH volume, HH type, and amount of resection or disconnection were not correlated to seizure freedom. A total of 4 patients (10%) died, 2 immediately after surgery and 2 later. All of them had undergone a resection, as opposed to GKS, and still had seizures. Postoperatively, persistent neurological deficits were seen in 1 patient; 34% of patients had mild hormonal problems; and 59% experienced weight gain of at least 6.8 kg (average gain 12.7 kg). Conclusions Surgical or GKS procedures in adults with HH provided seizure freedom in one-third of patients. The only significant favorable prognostic factor was the absence of mental retardation. The overall mortality rate was high, at 10%. Other important morbidities were persistent hormonal disturbances and weight gain.

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Tài liệu tham khảo

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Thông tin xuất bản

Journal of Neurosurgery

Tập 117 Số 2

255-261

Thông tin tác giả