SAN DIEGO — Endoscopic resection of hypothalamic hamartomas appears to be just as efficacious as traditional trans- callosal resection, Dr. Yu-tze Ng reported during a poster session at the annual meetings of the American Epilepsy Society and the Canadian League Against Epilepsy.
In what he said is the largest study of its kind, Dr. Ng and his associates evaluated 37 patients who underwent a transcortical, transventricular, endoscopic resection of hypothalamic hamartomas between October 2003 and April 2005 and who had at least 1 year of follow-up. The surgery was performed with an endoscope held by an articulated pneumatic arm and tracked with a frameless stereotactic neuronavigation system, said Dr. Ng, a pediatric epileptologist with the division of pediatric neurology at The Barrow Neurological Institute/St. Joseph's Hospital and Medical Center in Phoenix.
The mean age of patients was 16 years, and most (22) were male. Each patient had an average of 18 seizures per day and was on an average of 2 antiepileptic drugs. Most patients (82%) had trademark gelastic seizures at the time of surgery.
Postoperative MRI showed 100% resection and disconnection of the hypothalamic hamartoma from the hypothalamus in 12 patients. There were no mortalities.
At the most recent follow-up, which was a mean of 20 months, of the 37 patients 49% were seizure free, 70% had a greater than 90% reduction in their seizures, and another 22% had a 50%–90% reduction in their seizures.
“I was a little bit surprised that the seizure-free rate was only 49%,” Dr. Ng said in an interview.
“Although the majority had at least more than a 90% reduction in seizures, most of the patients had seemed to be seizure free and doing very well.”
He added that 38% of patients were off all antiepileptic drugs, and 67% reported improved cognition and/or behavior.
In their poster, the researchers noted that patients undergoing endoscopic resection had significantly shorter postsurgical hospital stays, compared with patients at the medical center who have undergone transcallosal resection (a mean of 5.8 days vs. 8.7 days, respectively).
However, there was no significant difference in the efficacy rate between the two procedures.
“Currently our neurosurgeon prefers performing the endoscopic resection although every case is reviewed on an individual basis,” they wrote.
“If the hypothalamic hamartoma tumor is too large and attached bilaterally to the hypothalamus, transcallosal resection may be performed.”
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