title: Robot Assisted Stereotactic Laser Ablation for a Radiosurgery Resistant Hypothalamic Hamartoma.
abstract: Hypothalamic hamartomas (HH) are benign tumors that can cause significant morbidity in adults as a cause of epilepsy, particularly gelastic seizures. Open and endoscopic resections of HH offer good seizure control but have high rates of morbidity and are technically challenging. Stereotactic radiosurgery has been an alternative treatment; however, it results in comparably poor seizure control. Recently, in children, stereotactic laser ablation has shown promise as a surgical technique that can combine the best features of both of these approaches for the treatment of HH. Here we present the first reported use of a frameless robot-assisted stereotactic system to treat an HH. The patient had failed two previous Gamma Knife radiosurgery treatments. Post-procedure he had a stable, but unintentional weight loss of 20 kg and a transient episode of hemiparesis the night of the operation. At six months postoperatively the patient remained seizure free. Stereotactic laser ablation may represent a new standard in the treatment of HH in adults, especially in those who have failed radiosurgery. Further study is warranted in this population to determine efficacy and safety profiles.
authors.affiliation: Department of Neurosurgery, Penn State Milton S Hershey Medical Center.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Brandmeir
authors.affiliation: Department of Neurology, Penn State Milton S Hershey Medical Center.
authors.forename: Vinita
authors.initials: V
authors.lastname: Acharya
authors.affiliation: Department of Neurosurgery, Penn State Milton S Hershey Medical Center.
authors.forename: Michael
authors.initials: M
authors.lastname: Sather
keywords: frameless; gelastic seizure; hypothalamic hamartoma; laser; robotic surgery; rosa; stereotactic