Endoscopic transsphenoidal resection of hypothalamic hamartoma

Abstract

This abstract discusses two clinical cases of hypothalamic hamartoma (HH) which have not yet been described in any Russian or international papers, and presents the details of endoscopic resection technique with a transsphenoidal approach. Patient R., 16 years old male with a 9-year history, epileptic seizures every 5–6 days. On MRI- 1.5 × 1.4 × 1.4 cm HH and FCD of the right occipital lobe. Three seizures were detected during video-EEG monitoring. Patient M., 23 years old female with a 16-year history of illness, epileptic seizures once in a week. On MRI - 2.44 × 2.79 × 2.68 cm HH. Two seizures were detected during video-EEG. In both cases surgical excision by transsphenoidal endoscopic approach was performed. First patient was discharged in satisfactory condition on the 7th day after surgery, and didn't have neurological deficit, electrolyte disorders (hypo- or hypernatremia, polyuria, polydipsia), visual disorders (hemianopsia or reduced visual acuity). Second patient in the early postoperative period had electrolyte disorders (hyponatremia), which were reversed after using hypo-osmolar solutions and mineralocorticoids. There were no visual impairments (hemianopia or visual acuity reduction). The patient was discharged in satisfactory condition on the 7th day after the surgery. In 18 months after surgery both patients are seizure free (Engel I). Clinical observation data suggest that transsphenoidal resection of HH in patients with drug-resistant epilepsy is possible. Our experience shows that refractory epilepsy associated with HH can be safely and effectively treated with transsphenoidal resection of HH, with the possibility of radical cure and disease control.