A subscription to JoVE is required to view this content. Sign in or start your free trial.
Hypothalamic hamartomas are rare, non-neoplastic congenital malformations mainly arising from the inferior hypothalamus or tuber cinereum. Surgical treatment is one of the most effective options, and the surgical approach must be precisely determined for each patient. Here, we describe the full-endoscopic technique for resecting hypothalamic hamartomas.
Hypothalamic hamartomas (HH) are rare developmental anomalies of the inferior hypothalamus that often cause refractory epilepsy, including gelastic seizures. Surgical resection is an effective method to treat drug-resistant epilepsy and endocrinopathy in a suitable patient group. Open surgery, endoscopic surgery, ablative procedures, and stereotactic radiosurgery can be utilized. In this study, we aimed to describe the full-endoscopic approach for HH resection. The technique involves the use of an intraoperative ultrasonography (USG) system, a 30° rigid endoscope system that has an outside diameter of 2.7 mm with two working channels, a stylet that has an outer diameter of 3.8 mm, a monopolar coagulation electrode, a fiberoptic light guide, and the endovision system. Microforceps and monopolar electrocautery are the two main surgical instruments for HH removal. The protocol is easy to apply after a particular learning curve has been passed and shorter than open surgical approaches. It leads to less blood loss. Full-endoscopic surgery for HH is a minimally invasive technique that can be applied safely and effectively with good seizure and endocrinological outcomes. It provides low surgical site pain and early mobilization.
Hypothalamic hamartomas (HHs) are non-neoplastic, heterotrophic tissues that contain neuronal and glial tissue in an abnormal distribution. Incidence rates of HHs are 1 in 50,000-1,000,000 people with male predominance1. HHs present different clinical symptoms, such as precocious puberty, cognitive impairment, behavioral changes, and various types of seizures, most characteristically, gelastic seizures. Mostly gelastic seizures, as well as other seizure types, are extremely refractory to antiepileptic drugs (AEDs)2,3.
Based on their morphology and relation to....
The study protocol was approved by the institutional review board of Istanbul University Faculty of Medicine. Informed consent was obtained from patients for this study.
1. Preoperative procedures
NOTE: Preoperative evaluation is similar to any other medically intractable epilepsy patient. Routine scalp electroencephalography (EEG) monitoring and video-EEG monitoring, interictal and ictal single photon emission computed tomography (SPECT), magnetic re.......
An example of a patient treated by a full-endoscopic approach for HH resection has been presented. The preoperative MRI, intraoperative endoscopic view, and postoperative MRI have been shown in Figure 1, Figure 2, and Figure 3. There was minimal blood loss during the procedure, so it could not be measured. The procedure is short for a surgeon experienced in neuroendoscopy. For the represented case, the operation dur.......
In 2003, Delalande classified HHs into four subtypes. Type 1 HHs are small peduncular lesions attached to the tuber cinereum, type 2 HHs are lesions protruding to the third ventricle, type 3 lesions are the combination of type 1 and type 2 HHs, and type 4 HHs are large lesions with a broad attachment to both mammillary bodies and hypothalamus and have an extension to the interpeduncular cistern8. Depending on the location of the HH, various open surgery approaches have been described. For HHs near.......
There is no funding source for this study.
....Name | Company | Catalog Number | Comments |
Burr-hole probe of intraoperative ultrasound system | Hitachi | UST-52114P | Aloka Linear UST-52114P, Frequency Range: 8 – 3 MH, Scan Angle: 90° FOV |
Fiberoptic light guide | RiwoSpine | 806635231 | 80663523 fiber light cable Ø 3.5 mm, TL 2.3 m, 8095.09 adaptor endoscope side, 8095.07 adaptor projector side |
Intraoperative Ultrasound system | Hitachi | Hitachi Arietta 70, Tokyo, Japan | |
Microforceps | RiwoSpine | 89240.3023 | |
Monopolar-coagulating electrode | RiwoSpine | 8922095000 | |
Rigid neuroendoscope | Karl Storz | 8921092051 | 30° Hopkins pediatric telescope, outside diameter 2.7 mm |
Sheath for the telescope | Karl Storz | 892209510 | 3.8 mm outside diameter with two working channels |
This article has been published
Video Coming Soon
ABOUT JoVE
Copyright © 2024 MyJoVE Corporation. All rights reserved