Surgical strategies for approaching hypothalamic hamartomas causing gelastic seizures in the pediatric population: Transventricular compared with skull base approaches

Iman Feiz-Erfan, Eric M. Horn, Harold L. Rekate, Robert F. Spetzler, Yui Tze Ng, Jeffrey V. Rosenfeld, John F. Kerrigan

Research output: Contribution to journalArticlepeer-review

43 Scopus citations

Abstract

Object. The authors provide evidence that direct resection of hypothalamic hamartomas (HHs) can improve associated gelastic and nongelastic seizures. Methods. Ten children younger than 17 years of age underwent resection of HHs (nine sessile and one pedunculated) that were causing refractory epilepsy. Lesions were approached from above transventricularly through a transcallosal anterior interforniceal approach in six cases, endoscopically through the foramen of Monro in one, and from below with a frontotemporal craniotomy including an orbitozygomatic osteotomy in three. Medical charts were reviewed retrospectively, and follow-up data were obtained through office records and phone calls. Follow-up periods ranged between 12 and 84 months (mean 16.8 months). All patients in whom the approach was from above had sessile HHs. Five were free from seizures at follow up and two had a reduction in seizures of at least 95%. The transventricular route allowed excellent exposure and visualization of the local structures during resection. Among the three patients in whom the approach was from below, one became free of seizure after two procedures and one had a 75% reduction in epilepsy; the latter two had sessile HHs. The exposure was inadequate, and critical tissue borders were not readily apparent. Although the HH was adequately exposed and resected, the epilepsy persisted in the third patient, who had a pedunculated lesion. The overall rate of major permanent hypothalamic complications appeared to be slightly lower for the orbitozygomatic osteotomy group. Conclusions. Sessile lesions are best approached from above. Approaches from below adequately expose pedunculated hamartomas. The likelihood of curing seizures seems to be higher when lesions are approached from above rather than from below.

Original languageEnglish (US)
Pages (from-to)325-332
Number of pages8
JournalJournal of neurosurgery
Volume103 PEDIATRICS
Issue numberSUPPL. 4
DOIs
StatePublished - Oct 2005

Keywords

  • Gelastic seizure
  • Hamartoma
  • Hypothalamus
  • Pediatric neurosurgery

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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