Stereoelectroencephalography-guided radiofrequency thermocoagulation for the treatment of hypothalamic hamartoma related epilepsy

Abstract

Objective To discuss the clinical application value of stereo-electroencephalography (SEEG) guided radiofrequency thermocoagulation (RF-TC) in the treatment of hypothalamic hamartoma (HH) related epilepsy. Methods A retrospective analysis was conducted on the clinical data of 7 consecutive patients with epilepsy caused by HH who underwent SEEG guided RF-TC at Department of Neurosurgery, Beijing Fengtai Hospital from June 2015 to January 2018. The clinical data included detailed history of illness, semiology, electroencephalography (EEG) and imaging results. Presurgical evaluation suggested that the epileptogenic zone was hypothalamic hamartoma. Then the SEEG electrodes were implanted using stereotactic frame and video EEG monitoring was conducted. Contacts with seizure onset patterns were chosen for ablation through RF-TC. After the ablation, video-EEG monitoring was still carried out. If the epileptic discharge did not disappear, the second RF-TC was carried out until the epileptic discharge disappeared. The postoperative complications were analyzed and post-operative seizure outcome was evaluated based on the Engel outcome classification at follow-up with telephone or clinical visits. Results Seven patients were followed up with a duration of 19.6±11.1 months. Among them, 5 were seizure free (EngelⅠ) and 1 achieved 75% decrease (Engel Ⅲ) in seizure frequency. One case had no obvious improvement (Engel Ⅳ). Postoperative complications occurred in 3 patients which included hyperthermia, lethargy, diabetes insipidus, electrolyte disorder and memory decline. All complications were resolved after treatment. Conclusion This study has suggested that SEEG guided RF-TC is an effective and safe treatment for seizure control in patients with HH. Complete disconnection between hypothalamus and hamartoma with RF-TC is essential for favorable surgical outcome. Key words: Epilepsy; Stereoelectroencephalography; Hypothalamic hamartoma; Radiofrequency thermocoagulation