Published online Mar 28, 2015. doi: 10.5412/wjsp.v5.i1.65
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.
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.