title: Rare primary tumours of the hypothalamus in adults: clinical course and surgical treatment.
abstract: OBJECTIVE
  The paper presents the operative technique and the results of treatment of adult patients with primary tumours of the hypothalamus, including rare ones. The aim of the study was to show the possibility of safe surgical treatment of rare tumours of the hypothalamus through a bifrontal basal interhemispheric trans-lamina terminalis approach.
  
  
  METHODS
  Five patients with tumours of the hypothalamus were operated on in the Neurosurgical Clinic in Sosnowiec between 1990 and 2008. There were 2 patients with craniopharyngiomas located exclusively in the third ventricle, and single patients with gemistocytic astrocytoma, Langerhans cell histiocytosis X and hamartoma of the hypothalamus each. The patients were treated surgically with a bi-frontal basal interhemispheric trans-lamina terminalis approach. In two cases, the neuronavigation system with the use of tractography (DTI) was used to determine the location of the lamina terminalis, the posterior surface of the optic chiasm and the optic tracts.
  
  
  RESULTS
  All lesions were resected totally, except for partially resected hamartoma of the hypothalamus. The most common postoperative complication was diabetes insipidus, which was transient in two cases. A long-lasting follow-up of all the patients operated on did not reveal regrowth of the lesion.
  
  
  CONCLUSIONS
  The bifrontal basal interhemispheric trans-lamina terminalis approach allows for radical resection of primary tumours of the hypothalamus while avoiding serious post-operative deficits. This approach enabled the preservation of the olfactory bulb and tract and prevented damage of the frontal lobes. The use of DTI helped to establish the location and borders of the lamina terminalis, to establish the posterior surface of the optic chiasm and the optic tracts, and to save the anterior and lateral wall of the hypothalamus.
authors.affiliation: Department of Neurosurgery, Sosnowiec, Medical University of Silesia, Katowice. majchrzak.mr@gmail.com
authors.forename: Krzysztof
authors.initials: K
authors.lastname: Majchrzak
authors.forename: Grażyna
authors.initials: G
authors.lastname: Bierzyńska-Macyszyn
authors.forename: Barbara
authors.initials: B
authors.lastname: Bobek-Billewicz
authors.forename: Henryk
authors.initials: H
authors.lastname: Majchrzak
authors.forename: Piotr
authors.initials: P
authors.lastname: Ładziński
mesh_terms: D000328:Adult; D002551:Cerebral Ventricle Neoplasms / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D007031:Hypothalamus / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures; D011044:Poland; D011184:Postoperative Period; D035583:Rare Diseases