Radiosurgery Techniques in the Treatment of Epilepsy Related to Hypothalamic Hamartomas (Systematic Review)

Abstract

Various radiosurgery (RS) techniques are available for the therapy of epilepsy related to hypothalamic hamartomas (HH). As shown in previous reports, each RS method can reduce the frequency of seizures, as well as behavioral and cognitive alterations related to HH. This review summarizes the safety and efficacy of the most frequently used RS techniques for HH patients, with a particular focus on the Gamma Knife RS, interstitial brachytherapy, and linear accelerator (LINAC) RS. Literature compilation was achieved through use of a wide spectrum of information—namely, Cochrane Library, PubMed®, and the National Institute of Health (NIH) clinical trials register. All identified reports were peer-reviewed and less than 20 years old. Relevant patient information, including RS method, follow-up, seizure outcome, and side effects, were selected from the above databases. Thirty-four reports with a total number of 123 patients, including 48 patients from singular randomized trial, were included in the review. The most common clinical presentations were gelastic seizures and cognitive dysfunctions. All RS techniques demonstrate approximately the same seizure reduction outcomes achieving maximal values of 90%. The brachytherapy was reported to have a higher risk of brain edema or memory deterioration compared to the Gamma Knife or LINAC-based RS. Common limitations for the RS therapies included large sizes of hamartomas and their prolonged time latencies. RS is the least invasive curative therapy with a lower rate of complications compared to surgery. RS can be considered the therapy of choice especially for small or medium-sized HH.