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Journal of Neurosurgical Sciences 2021 Oct 14

DOI: 10.23736/S0390-5616.21.05442-4


language: English

Non-robotized frameless stereotactic magnetic resonance guided laser interstitial thermal therapy for hypothalamic hamartoma: preliminary results of 2 cases and review of the literature

Giuseppe DI PERNA 1, 2 , Mattia PACETTI 2, Domenico TORTORA 3, Lino NOBILI 4, 5, Armando CAMA 2, Gianluca PIATELLI 2, Alessandro CONSALES 2

1 Neurosurgery Unit, Department of Neuroscience Rita Levi Montalcini, University of Turin, Turin, Italy; 2 Division of Neurosurgery, IRCCS Istituto Giannina Gaslini, Genova, Italy; 3 Neuroradiology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy; 4 Child Neuropsychiatry, IRCCS G. Gaslini Institute, Genoa, Italy; 5 Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Child and Maternal Health (DINOGMI), University of Genoa, Genoa, Italy


BACKGROUND: Various strategies have been proposed for the treatment of gelastic seizures due to hypothalamic hamartomas (HH), advancing from surgical removal techniques toward functional disconnection strategies. One of the most recent procedure is the Magnetic Resonance guided Laser Interstitial Thermal Therapy (MRg-LITT), which has progressively proved to be a safe and effective technique for hamartomas ablation. In this paper, the authors’ preliminary experience with the first two patients treated with this technique in Italy is presented, in order to underline the feasibility of a pure non robotized frameless technique (FS MRg-LITT) while confirming the procedure effectiveness on seizure control.
METHODS: Patients undergoing FS MRg-LITT for the treatment of HH related gelastic seizures since January 2020 were included. A two steps procedure was performed by using the neuronavigation system to define the entry point, the trajectories and to assess the accuracy. Visualase Laser Ablation System was then used for the MR guided ablation of the HH. A multidisciplinary (neurosurgeons, epileptologist, neuroradiologist) institutional board evaluated the patients both in the perioperative period and during follow up.
RESULTS: A total number of 2 pediatric patients were described. The mean operative time resulted to be 6 hours while the mean accuracy was 0.4 mm. No peri-operative complications were reported. The mean length of stay was 4 days. Lastly, at 1-year follow up both patients resulted to be seizure free and endocrinological functions were preserved.
CONCLUSIONS: FS MRg-LITT for the treatment of HH-related epilepsy could represent an effective technique, being able to guarantee adequate level of accuracy and potentially extending the accessibility of MRg-LITT by lowering its costs and simplifying the overall procedure.

KEY WORDS: Laser interstitial thermal therapy; Hypothalamic hamartoma; Stereotactic laser ablation; Gelastic seizure; Non-robotized frameless image guided stereotaxy

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