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Orbitozygomatic resection for hypothalamic hamartoma and epilepsy: patient selection and outcome

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Abstract

Purpose

This study aims to examine the outcomes of ten patients after orbitozygomatic (OZ) pterional surgery in cases of refractory epilepsy caused by hypothalamic hamartomas (HH).

Methods

Ten patients with HH and treatment-resistant epilepsy (mean age 18.3 years, range 0.7 to 42.7) underwent HH resection with an OZ approach (n = 8) or an OZ approach combined with a transventricular endoscopic approach (n = 2). Follow-up for the patients ranged from 0.5 to 6.2 years (mean 3.1). Outcomes were prospectively monitored with the use of a proprietary database.

Results

Four patients (40%) are seizure-free, and four (40%) have had greater than 50% reduction in seizures. One patient had no significant change in seizure frequency, and one patient died unexpectedly 2.8 years after surgery. Six patients had total or near-total HH resection (98–100% of HH lesion volume). Of these, four of six (66%) were seizure-free, and two had at least greater than 50% reduction in seizures. Residual complications include diabetes insipidus (n = 1), poikilothermia (n = 1), visual field deficit (n = 1), and hemiparesis (n = 1). Eight families (80%) reported improved quality of life.

Conclusions

Patients with treatment-resistant epilepsy and tumors with an inferior or horizontal plane of attachment to the hypothalamus should continue to be approached from below. Those with both intrahypothalamic and parahypothalamic components may require approaches from above and below, either simultaneously or staged. For appropriately selected patients, the success of controlling seizures with an OZ is comparable to results utilizing transcallosal or transventricular approaches. The likelihood of controlling seizures appears to correlate with extent of resection.

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Acknowledgments

We thank the Neuroscience Publications Department at Barrow Neurological Institute for editing and helping to prepare the manuscript and Maggie Varland MSN, MBA for coordinating the study.

Disclosures

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix, AZ, USA

    Adib A. Abla, Harold L. Rekate, David A. Wilson, Scott D. Wait, Timothy D. Uschold & Peter Nakaji

  2. Division of Neuroradiology, Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix, AZ, USA

    Erin Prenger

  3. Division of Neurology, Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix, AZ, USA

    Yu-tze Ng & John F. Kerrigan

  4. Neuroscience Publications, Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, 350 West Thomas Road, Phoenix, AZ, 85013, USA

    John F. Kerrigan

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  1. Adib A. Abla
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  2. Harold L. Rekate
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  3. David A. Wilson
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  8. Peter Nakaji
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  9. John F. Kerrigan
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Correspondence to John F. Kerrigan.

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Abla, A.A., Rekate, H.L., Wilson, D.A. et al. Orbitozygomatic resection for hypothalamic hamartoma and epilepsy: patient selection and outcome. Childs Nerv Syst 27, 265–277 (2011). https://doi.org/10.1007/s00381-010-1250-7

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  • DOI: https://doi.org/10.1007/s00381-010-1250-7

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