Abstracts

To present our single-center experience with a frameless robot-guided endoscopic system for the transventricular disconnection of hypothalamic hamartomas (HH) associated with drug-resistant epilepsy., Fourty-three patients (9m to 34y, median age: 10y) were operated on either through a pterional approach (8) or by means of transventricular endoscopy (21) or subsequently by both techniques (14), in order to disconnect the HH below or at the wall of the third ventricle. For the endoscopic approach we used a frameless stereotactic robot-guided navigation (Neuromate[reg], Schaerer-Mayfield). The trajectory of the endoscopic approach was defined by the hamartomas plane of attachment on the hypothalamus, for which we have proposed an anatomo-topographic classification., In terms of seizure outcome, we achieved the best results in HH with a vertical broad plane of attachment, extending into the third ventricle, enabling us to disconnect it through the endoscopic route. In this subtype (n=12), 83% of the patients became seizure-free, as compared to 43% in the other three types (horizontal attachment, attachment in multiple planes and giant HH). Other parameters, such as the patients age, seizure type and frequency or the duration of illness, were not significantly related with the outcome.
In all, of 42 patients followed up, 21 (50%) became seizure-free and 2 had rare events, while 17 (41%) had a worthwhile reduction in their seizure frequency, and 2 patients remained unchanged.
Furthermore, improvement in several patients with disease-related cognitive and behavioural disturbances could be objectified postoperatively.
In terms of surgery-related morbidity, the endoscopic approach had a significantly lower complication rate., Our results confirm the safety and efficacy of the disconnection of HH extending into the third ventricle with our robot-guided endoscopic approach.,