title: Extradural temporopolar approach for parahypothalamic hypothalamic hamartoma and use of posterior communicating artery as resection margin pointer.
abstract: BACKGROUND
  Hypothalamic hamartomas (HH) are malformations originating from the hypothalamus and are associated with seizures, hormonal and behavioral abnormalities.
  
  
  METHODS
  Most patients, especially those with a typical syndrome characterized by gelastic seizures, precocious puberty, cognitive decline, and behavior problems, are diagnosed in childhood. Pedunculated and parahypothalamic types of hamartomas are attached to the floor by a narrow or wide peduncle in the absence of distortion of the overlying hypothalamus. This location is most commonly associated with a clinical presentation of precocious puberty, and surgical removal has proved curative in small case series. Enthusiastic resection of hypothalamic lesions are known to produce severe hypothalamic disturbance while under resection might mean inadequate response to surgery.
  
  
  CONCLUSIONS
  In this article, the authors describe the use of extradural temporopolar approach to hypothalamic hamartoma as an improvisation to improve access with reduced morbidity and describe a surgical nuance of using posterior communicating artery to determine a safe but maximal resection margin.
authors.affiliation: Division of Pediatric Neurosurgery, Department of Neurosurgery, Amrita Institute of Medical Sciences and Research Centre, Ponekkara, Kochi, 682041, India, dr.suhas@gmail.com.
authors.forename: Suhas
authors.initials: S
authors.lastname: Udayakumaran
authors.forename: Parasuraman
authors.initials: P
authors.lastname: Ayiramuthu
authors.forename: Dilip
authors.initials: D
authors.lastname: Panikar
mesh_terms: D002675:Child, Preschool; D002941:Circle of Willis / Q000601:surgery; D003072:Cognition Disorders / Q000209:etiology; D006222:Hamartoma / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D007027:Hypothalamic Diseases / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008297:Male; D008326:Mammillary Bodies / Q000473:pathology; D019635:Neurosurgical Procedures / Q000379:methods*; D011629:Puberty, Precocious / Q000209:etiology; D012640:Seizures / Q000209:etiology; D013701:Temporal Bone / Q000601:surgery*