Gamma knife radiosurgery for refractory epilepsy caused by hypothalamic hamartomas.
BACKGROUND
Hypothalamic hamartomas are associated with precocious puberty and chronic epilepsy characterized by gelastic seizures. The seizure disorder is usually refractory to most antiepileptic drugs. Gamma knife surgery has emerged as an alternative to microsurgical removal or radiofrequency ablation to improve seizure control. We present our experience with radiosurgery in 4 patients afflicted by this disorder.


METHODS
Using gamma knife radiosurgery, 4 patients with intractable gelastic seizures and complex epilepsy were managed. Patient age varied from 5 to 29 years. The duration of symptoms was 4-28 years. A conformal radiosurgery plan was designed with a mean of 4.25 isocenters to cover the hamartoma at the 50% isodose line. A mean margin dose of 17.5 Gy was used. The clinical outcome was evaluated with the Engel scale.


RESULTS
No complication occurred. After a median follow-up of 22 months, 3 patients had shown some improvement, with 2 attaining Engel class II status.


CONCLUSIONS
Gamma knife surgery is a promising alternative to microsurgical removal for patients with refractory epilepsy caused by hypothalamic hamartomas.
Mathieu
David
D
Department of Neurological Surgery, University of Pittsburgh, and Center for Image-Guided Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA.
Kondziolka
Douglas
D
Niranjan
Ajay
A
Flickinger
John
J
Lunsford
L Dade
LD
D000293:Adolescent; D000328:Adult; D002675:Child, Preschool; D004827:Epilepsy / Q000209:etiology / Q000532:radiotherapy* / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006222:Hamartoma / Q000150:complications / Q000601:surgery*; D006801:Humans; D007029:Hypothalamic Neoplasms / Q000150:complications / Q000532:radiotherapy* / Q000601:surgery*; D008297:Male; D016634:Radiosurgery; D016896:Treatment Outcome