Brandmeir N, Acharya V, Sather M. Robot Assisted
Stereotactic Laser Ablation for a Radiosurgery Resistant Hypothalamic
Hamartoma. Cureus 2016 Apr; 8(4): e581. doi:10.7759/cureus.581
Abstract
Hypothalamic hamartomas (HH) are benign tumors that can
cause significant morbidity in adults as a cause of epilepsy, particularly
gelastic seizures [GS]. Open and endoscopic resections of HH offer good seizure
control but have high rates of morbidity and are technically challenging.
Stereotactic radiosurgery has been an alternative treatment; however, it
results in comparably poor seizure control. Recently, in children, stereotactic
laser ablation has shown promise as a surgical technique that can combine the
best features of both of these approaches for the treatment of HH. Here we
present the first reported use of a frameless robot-assisted stereotactic
system to treat an HH. The patient had failed two previous Gamma Knife
radiosurgery treatments. Post-procedure he had a stable, but unintentional
weight loss of 20 kg and a transient episode of hemiparesis the night of the
operation. At six months postoperatively the patient remained seizure free.
Stereotactic laser ablation[SLA] may represent a new standard in the treatment
of HH in adults, especially in those who have failed radiosurgery. Further
study is warranted in this population to determine efficacy and safety
profiles.
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From the article:
The patient is a 63-year-old man with a history of GS since
the age of three. Imaging had consistently demonstrated a 1 cm non-enhancing
mass on the wall of the left hypothalamus.. All treating physicians involved in
the case felt that this mass represented an HH. As a child he also experienced
generalized tonic-clonic seizures, but, as an adult, only auras of “riding an
elevator.” Seven years and again one year prior to presenting again for
surgical management, the patient had undergone Gamma Knife Radiosurgery (GKS)
for his HH. The first GKS treatment consisted of one 8 mm collimated shot
treated to 17 Gy to 50% isodose line. The second GKS treatment consisted of another
8 mm collimated shot delivering 17 Gy to the 50% isodose line. He did
experience some temporary decrease in GS frequency after each procedure, but
his GS returned to their usual rate within two months each time. After being
made aware of the option of SLA and the associated risks and benefits, the
patient wished to proceed with surgery. At that time informed consent for the
procedure and the potential preparation of academic materials related to the
procedure were obtained…
At his six-month follow-up visit, the patient was
neurologically intact, seizure free, down to two anti-epileptic drugs from
three, and had an improved mentation, alertness, and speech fluency compared to
his preoperative function…
In conclusion, frameless robot-assisted SLA may be an
effective and safe method for the treatment of HH in adults with GS who have
failed stereotactic radiosurgery. Considering the potential decrease in
morbidity when compared to endoscopic resection and the relatively high
efficacy as demonstrated in children, SLA may be the treatment of choice in
adults with HH. This application will require further research. This paper also
demonstrates the potential role of SLA for patients with HH who have failed GKS
and who do not wish to undergo resection. Finally, this report highlights some
complications that may be unique to adults or to adults who have had previous
radiosurgery, specifically a transient acute, postoperative hemiparesis and
unintentional weight loss. Fortunately, in the case of our patient, side
effects were either temporary or clinically silent, but further study of this
technique in this patient population will be necessary to determine its full
side effect profile.
http://www.cureus.com/articles/4394-robot-assisted-stereotactic-laser-ablation-for-a-radiosurgery-resistant-hypothalamic-hamartoma?utm_medium=email&utm_source=transaction
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