SURG-14. THE ARRAY OF TREATMENTS AVAILABLE FOR HYPOTHALAMIC HAMARTOMA IN THE SETTING OF INTRACTABLE SEIZURE: CURRENT STATE OF THE EVIDENCE FOR ENDOSCOPIC DISCONNECTION (AND RESECTION), LITT, AND RADIOTHERAPY

Abstract

Abstract Numerous minimally invasive approaches to hypothalamic hamartomas (HHs) have been developed though their efficacy in treating seizures has not been closely analyzed. A systematic review was performed using three databases per PRISMA in order to identify all studies comparing seizure outcomes for HHs treated via endoscopic disconnection (ED), resection (ER), ablation, and radiosurgery. Of the initial 235 studies, 67 studies which reported individual patient data were included for analysis encompassing a total of 229 patients (75/219 females). ED: A total of 82 (33 females, 40%) patients were treated via endoscopic disconnection. Mean follow-up was 18 months and 39 patients (48%) were Engel Class (EC) I, 23 patients (28%) were EC II, 15 patients (18%) were EC III, and 4 patients (4.9%) were EC IV. ER: A total of 31 (8 females, 26%) patients were treated via endoscopic resection. Mean follow-up was 18 months and 14 patients (45%) were Engel Class (EC) I, 8 patients (26%) were EC II, 0 patients (0%) were EC III, and 9 patients (29%) were EC IV. Ablation: A total of 83 (24 females, 32%) patients were treated via either LiTT or thermal ablation. Mean follow-up was 16 months and 57 patients (69%) were Engel Class (EC) I, 12 patients (14%) were EC II, 4 patients (4.8%) were EC III, and 10 patients (12%) were EC IV. Radiotherapy: A total of 33 (10, 32%) patients were treated via radiotherapy. Mean follow-up was 32 months and 18 patients (55%) were Engel Class (EC) I, 9 patients (27%) were EC II, 3 patients (9.1%) were EC III, and 3 patients (9.1%) were EC IV. Our findings suggest that patients treated with ablation had the highest percentage of seizure freedom, followed by radiotherapy, endoscopic disconnection, and endoscopic resection. Further studies are needed to determine the long-term efficacy and safety.