Neurological complications after gamma-knife radiosurgery for hypothalamic hamartoma.
BACKGROUND
The Gamma-knife technique is a safe and effective option for the treatment of hypothalamic hamartomas that produce epileptic seizures refractory to medical treatment and/or serious behavioral disorders. After this type of radiosurgery, an adequate symptomatic control is normally achieved, with notable decrease or even disappearance of the seizures. Radiological changes, such as a decrease in the size of the tumor or adjacent edema secondary to non-necrotizing radioinduced inflammatory reaction are unusual consequences. Side effects and neurological complications are also rare events.


METHODS
This report describes an unusual case of complete radiological resolution of a hypothalamic hamartoma as well as neurological complications after Gamma-knife surgery (receiving 13 Gy to the 85% isodose line, 1 cm(3) of tumor volume) in a 8-year-old boy who suffered from severe refractory seizures. After radiosurgery, the patient experienced a notable improvement in his symptoms, achieving seizure cessation within 3 months. However, 4 months after the procedure he presented drowsiness, fever and decreased level of consciousness due to a direct effect on the hypothalamus with local and regional edema secondary to the radiosurgery that was performed. He was successfully treated with corticosteroids (with a total duration of 11 months), and twelve months after the surgery, complete disappearance of both the nodular lesion and the secondary edema was observed. The patient remains seizure-free in the last 16 months, with remarkable changes in his behavior.


CONCLUSIONS
The present case shows that complete radiological resolution of a hypothalamic hamartoma after Gamma-knife technique is unusual but possible, without long-term neurological consequences. Nevertheless, despite its low incidence, if a patient presents neurological symptoms, primarily during the first year after intervention, possible complications of this type of surgery must be taken into account.
Department of Pediatrics, Hospital General Universitario Gregorio Marañón, Madrid, Spain. Electronic address: laura_bl@hotmail.com.
Laura
L
Butragueño Laiseca
Department of Pediatrics, Hospital General Universitario Gregorio Marañón, Madrid, Spain. Electronic address: nik.oik87@gmail.com.
Niki
N
Oikonomopoulou
Department of Neuropediatrics, Hospital General Universitario Gregorio Marañón, Madrid, Spain. Electronic address: mconchi82@yahoo.es.
María Concepción
MC
Miranda Herrero
Department of Neuropediatrics, Hospital General Universitario Gregorio Marañón, Madrid, Spain. Electronic address: estibalizbv@hotmail.com.
Estíbaliz
E
Barredo Valderrama
Department of Neuropediatrics, Hospital General Universitario Gregorio Marañón, Madrid, Spain. Electronic address: vazquezlopezmaria@gmail.com.
María
M
Vázquez López
Department of Neuropediatrics, Hospital General Universitario Gregorio Marañón, Madrid, Spain. Electronic address: annajd87@hotmail.com.
Ana
A
Jiménez de Domingo
Department of Pediatric Radiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain. Electronic address: aaguadodelhoyo@hotmail.com.
Alejandra
A
Aguado Del Hoyo
Department of Neurosurgery, Hospital General Universitario Gregorio Marañón, Madrid, Spain. Electronic address: rgarcia_leal@yahoo.es.
Roberto
R
García-Leal
Department of Radiation Oncology, Clínica La Luz, Madrid, Spain. Electronic address: rmmeirino@gmail.com.
Rosa M
RM
Meiriño
D002648:Child; D003244:Consciousness Disorders / Q000209:etiology*; D006222:Hamartoma / Q000628:therapy*; D006801:Humans; D007027:Hypothalamic Diseases / Q000628:therapy*; D008279:Magnetic Resonance Imaging; D008297:Male; D016634:Radiosurgery / Q000009:adverse effects*; D012640:Seizures / Q000209:etiology*
Epilepsy; Gamma-knife surgery; Gelastic seizures; Hypothalamic hamartoma; Intractable epilepsy; Radiosurgery