Full-Endoscopic Surgery for Hypothalamic Hamartoma Resection

Hypothalamic Hamartoma is a debilitating disorder causing intractable seizures and endocrinological problems. Full endoscopic resection provides outcomes similar to those of microscopic resection. Full endoscopic surgery is a minimally invasive surgery performed from a four centimeter incision with minimal brain tissue disruption.

It provides early mobilization, recovery, and return to daily life. Begin by introducing the endoscope through an established burr hole on the kocher's point. Under direct visualization, advance the endoscope through the foramen of Monro.

Visualize the hypothalamic hamartoma protruding from the floor and the lateral wall of the third ventricle. Coagulate the lesion by monopolar cautery from the working channel. Then remove the lesion with micro forceps, dissecting until reaching the pia and arachnoid membrane.

To achieve hemostasis, irrigate with isotonic saline solution or use monopolar coagulation. A patient with a hypothalamic hamartoma lesion at the inferior third ventricle protruding from the right hypothalamic region was selected for this study. The intraoperative endoscopic procedure resulted in the total resection and disconnection of the hypothalamic hamartoma.

This procedure's most important nuances are that it can be applied with a single neuro endoscope, including two working channels, and almost only with micro forceps and a radiofrequency ablator. After this procedure, salvage treatments like re-operation or stereotactic radiosurgery can be performed if there is a residual tumor due to the significance of the adjacent structures and if the patient has persisting symptoms.