Abstracts

Hypothalamic hamartomas (HHs) are rare developmental abnormalities of the inferior hypothalamus that often cause refractory, symptomatic, mixed epilepsy. Multiple surgical approaches have been described. We present a series of 39 patients where a transcortical, transventricular, endoscopic resection was performed., Forty-two patients with refractory epilepsy underwent surgical resection of HH between October 2003 and April 2005 at our institution, i.e. all patients with more than 12 month follow-up. All patients underwent endoscopic resection and were prospectively studied. Neurosurgery was performed with the endoscope held by an articulated pneumatic arm and tracked with a frameless stereotactic neuronavigation system. Data collection and follow-up was performed by personal interview. Three patients were excluded because they underwent combined surgical approaches (subfrontal and transcallosal)., The average age of the patients was 15.8 years (range 8 months to 55 years). There were 24 males. All 39 patients had very frequent seizures, usually multiple types. The average number of each patient[apos]s total daily seizures was 18.2 (range 0.1-192) and an average of 2.2 seizure types each. 33 (85%) patients had trademark gelastic seizures at the time of surgery. The patients were on an average of 2.0 antiepileptic drugs (AEDs). 25 patients had either cognitive and/or behavioral impairment. Postoperative MRI demonstrated 100% resection and disconnection of the HH from the hypothalamus in 12 patients. There were no mortalities. Significant morbidity was limited to one patient with residual hemiparesis. Two patients were lost to follow-up. At latest follow-up (average 20.1 months (range 13 to 28 months)), 18/37 (48.6%) patients were seizure-free, 26/37 (70.3%) patients had [gt]90% reduction in their seizures and another 8/37 (21.6%) of patients had 50-90% seizure reduction. Fourteen patients were off all AEDs. Twenty-five (67.6%) patients reported either improved cognition and/or behavior. The percentage of disconnection trended toward seizure freedom (p=0.069). The percentage of resection did not significantly correlate with seizure freedom (p=0.11). In an endoscopic resection group of 33 patients, the average length of post-surgical hospital stay was 5.8 days (SD=3.1) as compared to 18 patients who underwent transcallosal resection and stayed for 8.7 days (SD=4.7). This overall difference i.e. shorter hospital stay amongst the endoscopically resected patients was statistically significant (p[lt]0.03)., Endoscopic resection of HH is safe and effective for the treatment of seizures. Its efficacy appears to be comparable to transcallosal resection of HH, however with significantly shorter patient recovery time post-operatively.,