Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Surg Proced. Mar 28, 2015; 5(1): 65-74
Published online Mar 28, 2015. doi: 10.5412/wjsp.v5.i1.65
How would we deal with hypothalamic hamartomas?
Kyu Won Shim, Eun Kyung Park, Ju Seong Kim, Dong-Seok Kim
Kyu Won Shim, Eun Kyung Park, Ju Seong Kim, Dong-Seok Kim, Department of Pediatric Neurosurgery, Severance Children’s Hospital, Yonsei University College of Medicine, Brain Korea 21 Project for Medical Science, Seoul 120-752, South Korea
Author contributions: All authors contributed to this work.
Conflict-of-interest: There is no conflict of interests
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Dong-Seok Kim, MD, PhD, Professor, Department of Neurosurgery Pediatric Neurosurgery, Severance Children’s Hospital, Yonsei University College of Medicine, Seoul 120-752, South Korea.
Telephone: +82-2-22282150 Fax: +82-2-3939979
Received: September 28, 2014
Peer-review started: October 10, 2014
First decision: December 17, 2014
Revised: December 26, 2014
Accepted: January 15, 2015
Article in press: January 19, 2015
Published online: March 28, 2015

Hypothalamic hamartoma (HH) is usually associated with refractory epilepsy, cognitive impairment, and behavioral disturbance. There is now increasing evidence that HH can be treated effectively with a variety of neurosurgical approaches. Treatment options for intractable gelastic seizure in HH patients include direct open surgery with craniotomy, endoscopic surgery, radiosurgery with gamma knife and stereotactic radiofrequency thermocoagulation. Selection of treatment modalities depends on type and size of the HH and the surgeon’s preference. Two surgical techniques, resection and disconnection, had been described with favorable outcomes. Pretreatment evaluation, patient selection, surgical techniques, complications, and possible selection of treatment are discussed.

Keywords: Hypothalamic hamartoma, Epilepsy, Gelastic seizure, Transcallosal resection, Endoscopic surgery, Radiosurgery, Stereotactic radiofrequency ablation

Core tip: Neuronavigation-assisted neuroendoscopic surgery has been remarkably advancing. Furthermore high definition video recording system becomes its basic visualization system to facilitate the differentiation between normal tissue and abnormal tissue of hypothalamic hamartomas. Neuroendoscopic disconnection has been suggested to reduce the Gelastic seizure by the isolation of hypothalamic hamartomas (HHs) from surrounding structures. We are getting more powerful tools for performing sophisticated endoscopic disconnection surgery. Neuroendoscopic disconnection surgery used to be an optional surgery, but it becomes the first choice of surgery for HH with Gelastic seizure.