Gamma knife surgery for hypothalamic hamartomas accompanied by medically intractable epilepsy and precocious puberty: experience in Mexico.
OBJECTIVE
Hypothalamic hamartoma is a nonneoplastic malformative mass of neurons and glia in the region of the hypothalamus. Because of its location, open surgery is associated with high morbidity and mortality rates. Gamma knife surgery (GKS) may be an efficient and safe treatment approach, which produces little morbidity. The authors describe the results of GKS in three patients with hypothalamic hamartomas.


METHODS
All patients were male, aged 3, 12, and 15 years. The lesions were classified according to the Valdueza scale: one was Type IIb and two were Type IIa. The patients presented with gelastic seizures (15-20 per day), generalized epilepsy, behavioral abnormalities, and alterations of the sleep cycle. Precocious puberty was present in one patient. The Type IIb tumor had a volume of 1.8 cm3, and the Type IIa tumors were 597 mm3 and 530.1 mm3. The lesions received 12.5 Gy, 14 Gy, and 15 Gy, respectively, to the 50% isodose line. The patients were followed for 30 to 50 months. After 3 months, all patients showed improvement of their sleep, behavior, and epilepsy. At the present time, these patients are receiving low-dose antiepileptic agents and have achieved adequate social development and school integration.


CONCLUSIONS
Gamma knife surgery appears to be a good, safe, and effective option for the treatment of selected hypothalamic hamartomas. No morbidity or mortality was associated with these three cases.
Barajas
Marco A
MA
Neurosciences Division, Gamma Knife Unit, Neuroradiology Department, Hospital San Javier, Guadalajara, Jalisco, Mexico.
Ramírez-Guzman
Maria G
MG
Rodríguez-Vázquez
Carlos
C
Toledo-Buenrostro
Vinicio
V
Cuevas-Solórzano
Abel
A
Rodríguez-Hernández
Gabriel
G
D000293:Adolescent; D001927:Brain Diseases / Q000150:complications* / Q000208:ethnology / Q000473:pathology / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D004827:Epilepsy / Q000150:complications* / Q000175:diagnosis / Q000208:ethnology; D006222:Hamartoma / Q000150:complications* / Q000208:ethnology / Q000473:pathology / Q000601:surgery*; D006801:Humans; D007031:Hypothalamus / Q000473:pathology / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008297:Male; D008800:Mexico; D011629:Puberty, Precocious / Q000150:complications* / Q000208:ethnology / Q000503:physiopathology*; D011829:Radiation Dosage; D016634:Radiosurgery / Q000295:instrumentation*