Repeat stereotactic radiofrequency thermocoagulation in patients with hypothalamic hamartoma and seizure recurrence
Abstract Objective To evaluate the feasibility of repeat stereotactic radiofrequency thermocoagulation (re‐SRT) for patients with hypothalamic hamartoma (HH) and to clarify clinical and surgical factors for seizure outcomes. Methods Hypothalamic hamartoma patients with gelastic seizures (GSs) who un...
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| Format: | Article |
| Language: | English |
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Wiley
2020-03-01
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| Series: | Epilepsia Open |
| Subjects: | |
| Online Access: | https://doi.org/10.1002/epi4.12378 |
| _version_ | 1819024056942329856 |
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| author | Hiroshi Shirozu Hiroshi Masuda Shigeki Kameyama |
| author_facet | Hiroshi Shirozu Hiroshi Masuda Shigeki Kameyama |
| author_sort | Hiroshi Shirozu |
| collection | DOAJ |
| description | Abstract Objective To evaluate the feasibility of repeat stereotactic radiofrequency thermocoagulation (re‐SRT) for patients with hypothalamic hamartoma (HH) and to clarify clinical and surgical factors for seizure outcomes. Methods Hypothalamic hamartoma patients with gelastic seizures (GSs) who underwent SRT were retrospectively reviewed. Seizure outcomes were evaluated separately for GS and other types of seizures (non‐GS). Surgical complications were compared between re‐SRT and first SRT. Clinical and surgical factors related to both seizure recurrences after first SRT and final seizure outcomes were analyzed. Results Participants comprised 150 patients (92 males; median age at surgery, 8 years; range, 1.7‐50 years). Of those, 122 (81.3%) had non‐GS. Forty‐three patients (28.7%) underwent re‐SRT. Freedom from GS was achieved by first SRT in 103 patients (68.7%), second SRT in 30/40 (67.5%), third SRT in 3/10 (30.0%), and fourth SRT in 2/3 (66.7%). Finally, 135 patients (90.0%) became GS‐free. Ninety patients (73.8%) achieved non‐GS freedom, with first SRT in all except one case. Transient complications were more frequent with first SRT (118/150, 78.7%) than re‐SRT (35/56, 62.5%), whereas persistent complications were more frequent with re‐SRT (7/56, 12.5%) than with first SRT (3/150, 2.0%). Multivariate analyses revealed only younger age at surgery (≤1 year) as related to GS recurrence after first SRT, with no variables affecting final GS outcomes. Meanwhile, seizure type (tonic seizure), intellectual disability, and genetic syndromes were significant factors for both non‐GS recurrence and final outcomes. Multiple previous treatments were significantly related to final non‐GS outcomes as well. Size and subtype of HH and surgical factors were unrelated to seizure outcomes. Significance Repeat stereotactic radiofrequency thermocoagulation provides potential opportunities to achieve freedom from recurrent GS, albeit with increased risks of persistent complications. Non‐GS and intellectual disability could offer early surgical indications, and repeated ineffective treatments should be avoided. |
| first_indexed | 2024-12-21T04:48:44Z |
| format | Article |
| id | doaj.art-ad0c4812ab8f482baf1229cf7871b706 |
| institution | Directory Open Access Journal |
| issn | 2470-9239 |
| language | English |
| last_indexed | 2024-12-21T04:48:44Z |
| publishDate | 2020-03-01 |
| publisher | Wiley |
| record_format | Article |
| series | Epilepsia Open |
| spelling | doaj.art-ad0c4812ab8f482baf1229cf7871b7062022-12-21T19:15:30ZengWileyEpilepsia Open2470-92392020-03-015110712010.1002/epi4.12378Repeat stereotactic radiofrequency thermocoagulation in patients with hypothalamic hamartoma and seizure recurrenceHiroshi Shirozu0Hiroshi Masuda1Shigeki Kameyama2Department of Functional Neurosurgery National Hospital Organization Nishiniigata Chuo Hospital Niigata JapanDepartment of Functional Neurosurgery National Hospital Organization Nishiniigata Chuo Hospital Niigata JapanDepartment of Functional Neurosurgery National Hospital Organization Nishiniigata Chuo Hospital Niigata JapanAbstract Objective To evaluate the feasibility of repeat stereotactic radiofrequency thermocoagulation (re‐SRT) for patients with hypothalamic hamartoma (HH) and to clarify clinical and surgical factors for seizure outcomes. Methods Hypothalamic hamartoma patients with gelastic seizures (GSs) who underwent SRT were retrospectively reviewed. Seizure outcomes were evaluated separately for GS and other types of seizures (non‐GS). Surgical complications were compared between re‐SRT and first SRT. Clinical and surgical factors related to both seizure recurrences after first SRT and final seizure outcomes were analyzed. Results Participants comprised 150 patients (92 males; median age at surgery, 8 years; range, 1.7‐50 years). Of those, 122 (81.3%) had non‐GS. Forty‐three patients (28.7%) underwent re‐SRT. Freedom from GS was achieved by first SRT in 103 patients (68.7%), second SRT in 30/40 (67.5%), third SRT in 3/10 (30.0%), and fourth SRT in 2/3 (66.7%). Finally, 135 patients (90.0%) became GS‐free. Ninety patients (73.8%) achieved non‐GS freedom, with first SRT in all except one case. Transient complications were more frequent with first SRT (118/150, 78.7%) than re‐SRT (35/56, 62.5%), whereas persistent complications were more frequent with re‐SRT (7/56, 12.5%) than with first SRT (3/150, 2.0%). Multivariate analyses revealed only younger age at surgery (≤1 year) as related to GS recurrence after first SRT, with no variables affecting final GS outcomes. Meanwhile, seizure type (tonic seizure), intellectual disability, and genetic syndromes were significant factors for both non‐GS recurrence and final outcomes. Multiple previous treatments were significantly related to final non‐GS outcomes as well. Size and subtype of HH and surgical factors were unrelated to seizure outcomes. Significance Repeat stereotactic radiofrequency thermocoagulation provides potential opportunities to achieve freedom from recurrent GS, albeit with increased risks of persistent complications. Non‐GS and intellectual disability could offer early surgical indications, and repeated ineffective treatments should be avoided.https://doi.org/10.1002/epi4.12378gelastic seizurehypothalamic hamartomarecurrencereoperationstereotactic radiofrequency thermocoagulation |
| spellingShingle | Hiroshi Shirozu Hiroshi Masuda Shigeki Kameyama Repeat stereotactic radiofrequency thermocoagulation in patients with hypothalamic hamartoma and seizure recurrence Epilepsia Open gelastic seizure hypothalamic hamartoma recurrence reoperation stereotactic radiofrequency thermocoagulation |
| title | Repeat stereotactic radiofrequency thermocoagulation in patients with hypothalamic hamartoma and seizure recurrence |
| title_full | Repeat stereotactic radiofrequency thermocoagulation in patients with hypothalamic hamartoma and seizure recurrence |
| title_fullStr | Repeat stereotactic radiofrequency thermocoagulation in patients with hypothalamic hamartoma and seizure recurrence |
| title_full_unstemmed | Repeat stereotactic radiofrequency thermocoagulation in patients with hypothalamic hamartoma and seizure recurrence |
| title_short | Repeat stereotactic radiofrequency thermocoagulation in patients with hypothalamic hamartoma and seizure recurrence |
| title_sort | repeat stereotactic radiofrequency thermocoagulation in patients with hypothalamic hamartoma and seizure recurrence |
| topic | gelastic seizure hypothalamic hamartoma recurrence reoperation stereotactic radiofrequency thermocoagulation |
| url | https://doi.org/10.1002/epi4.12378 |
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