A Simple Technique for Endoscopic Hypothalamic Hamartoma Disconnection in Refractory Epilepsy: 2-Dimensional Operative Video

2020 ◽  
Vol 19 (2) ◽  
pp. E159-E160 ◽  
Author(s):  
Marcelo Budke ◽  
María Ángeles Pérez-Jiménez ◽  
José Hinojosa Mena-Bernal
Keyword(s):  
Refractory Epilepsy ◽  
Third Ventricle ◽  
Balloon Catheter ◽  
Gamma Knife Radiosurgery ◽  
Hypothalamic Hamartoma ◽  
Long Term Memory ◽  
Fogarty Catheter ◽  
Bipolar Coagulation ◽  
Foramen Of Monro ◽  
Stereotactic System

Abstract Hypothalamic hamartomas often cause refractory epilepsy, best controlled with surgery. A transcallosal interforniceal approach provides good outcomes although it has resulted in some complications including fornix lesions with transitory and permanent memory losses.1-2 Endoscopic disconnection is less invasive, avoids interhemispheric approach, callosotomy and fornix as well as propagation of epileptic discharges.3,4 Laser disconnection does not allow objective measurement of the vaporized tissue and can cause significant hypothalamic edema. We demonstrate a simple hypothalamic disconnection endoscopy technique using the VarioGuide frameless stereotactic system (Brainlab, Germany), bipolar coagulation electrode (Karl Storz, Germany), and 3-French Fogarty catheter (Edwards Lifesciences, USA).  We present a 12-yr-old right-handed girl who developed normally until 4 yr old when gelastic seizures began. Antiepileptic drugs and gamma knife radiosurgery did not control the seizures. Magnetic resonance imaging showed a nodular 13 mm left hypothalamic mass protruding into the third ventricle. The patient consented to surgery.  We used a rigid 30° 6-mm neuroendoscope (Aesculap, Germany) with VarioGuide to reach the ventricle. After visualizing the foramen of Monro, the bipolar coagulation electrode perforated holes along the hamartoma/hypothalamus interface. The Fogarty balloon catheter was inserted into each hole and gently inflated to connect the holes and disconnect the mass from the hypothalamus.  The patient's postsurgical recovery was excellent, presenting intact short- and long-term memory without neurological deficit or endocrine complications. She continues seizure-free 2 yr after surgery. We have successfully used this technique in 4 more cases and, if results continue to be good, will consider it a useful tool for these infrequent malformations.

scholarly journals Third ventricular colloid cyst causing acute hydrocephalus during early pregnancy: Clinical lessons from a case

2021 ◽  
Vol 12 ◽  
pp. 54
Author(s):  
Ching Chung Foo ◽  
Pasquale Gallo ◽  
Chandrasekaran Kaliaperumal
Keyword(s):  
Obstructive Hydrocephalus ◽  
Third Ventricle ◽  
False Negative ◽  
Colloid Cyst ◽  
Radiological Investigation ◽  
Foramen Of Monro ◽  
Acute Hydrocephalus ◽  
Healthy Neonate ◽  
Trimester Pregnancy ◽  
Colloid Cysts

Background: Colloid cysts of third ventricle are rare lesions which may present with symptoms of acute hydrocephalus. We report a case of acute obstructive hydrocephalus secondary to third ventricular colloid cyst and its management during 1st trimester pregnancy. Case Description: A 31-years-old lady presented to the emergency department with reduced consciousness. Computed tomography head showed obstructive hydrocephalus and an obstructing lesion near foramen of Monro suggestive of third ventricle colloid cyst. She underwent endoscopic resection of colloid cyst. Her pregnancy was only confirmed after surgery and she delivered a healthy neonate at full term. She has remained clinically well and had resumed her work as a general practitioner. Conclusion: This case illustrates that urinary pregnancy test may show false negative result but pregnancy should not preclude radiological investigation and neurosurgical intervention in patients with deteriorating neurological function.

Frameless neuronavigation in intracranial endoscopic neurosurgery

2001 ◽  
Vol 94 (1) ◽  
pp. 72-79 ◽  
Author(s):  
Henry W. S. Schroeder ◽  
Wolfgang Wagner ◽  
Wolfgang Tschiltschke ◽  
Michael R. Gaab
Keyword(s):  
Third Ventricle ◽  
Colloid Cyst ◽  
Endoscopic Approach ◽  
Arachnoid Cysts ◽  
Tumor Biopsy ◽  
Foramen Of Monro ◽  
Endoscopic Neurosurgery ◽  
Content Type ◽  
Multiloculated Hydrocephalus ◽  
Fine Print

Object. Frameless computerized neuronavigation has been increasingly used in intracranial endoscopic neurosurgery. However, clear indications for the application of neuronavigation in neuroendoscopy have not yet been defined. The purpose of this study was to determine in which intracranial neuroendoscopic procedures frameless neuronavigation is necessary and really beneficial compared with a free-hand endoscopic approach. Methods. A frameless infrared-based computerized neuronavigation system was used in 44 patients who underwent intracranial endoscopic procedures, including 13 third ventriculostomies, nine aqueductoplasties, eight intraventricular tumor biopsy procedures or resections, six cystocisternostomies in arachnoid cysts, five colloid cyst removals, four septostomies in multiloculated hydrocephalus, four cystoventriculostomies in intraparenchymal cysts, two aqueductal stent placements, and fenestration of one pineal cyst and one cavum veli interpositi. All interventions were successfully accomplished. In all procedures, the navigational system guided the surgeons precisely to the target. Navigational tracking was helpful in entering small ventricles, in approaching the posterior third ventricle when the foramen of Monro was narrow, and in selecting the best approach to colloid cysts. Neuronavigation was essential in some cystic lesions lacking clear landmarks, such as intraparenchymal cysts or multiloculated hydrocephalus. Neuronavigation was not necessary in standard third ventriculostomies, tumor biopsy procedures, and large sylvian arachnoid cysts, or for approaching the posterior third ventricle when the foramen of Monro was enlarged. Conclusions. Frameless neuronavigation has proven to be accurate, reliable, and extremely useful in selected intracranial neuroendoscopic procedures. Image-guided neuroendoscopy improved the accuracy of the endoscopic approach and minimized brain trauma.

Purely Endoscopic Resection of Colloid Cysts

2008 ◽  
Vol 62 (suppl_1) ◽  
pp. ONS51-ONS56 ◽  
Author(s):  
Jeremy D.W. Greenlee ◽  
Charles Teo ◽  
Ali Ghahreman ◽  
Bernard Kwok
Keyword(s):  
Endoscopic Resection ◽  
Third Ventricle ◽  
Colloid Cyst ◽  
Foramen Of Monro ◽  
The Third ◽  
Colloid Cysts ◽  
Study Support

Abstract Objective: To further assess the safety and long-term efficacy of endoscopic resection of colloid cysts of the third ventricle. Methods: A retrospective review of a series of 35 consecutive patients (18 male, 17 female) with colloid cysts treated by endoscopic surgery was undertaken. Results: The mean patient age was 32.4 years (range, 11–54 yr). Headache was the most common presenting symptom (22 patients). The average tumor size was 18 mm (range, 3–50 mm). The endoscopic technique could not be completed in six patients, necessitating conversion to an open craniotomy and a transcortical approach to the colloid cyst. All patients had histologically confirmed colloid cysts of the third ventricle, and complete resection of the lesion was confirmed macroscopically and radiologically in all patients. There were no deaths. Two patients developed aseptic meningitis without any permanent sequelae. One patient developed unilateral hydrocephalus attributable to obstruction of the foramen of Monro, which was treated with endoscopic septum pellucidotomy. The median follow-up period was 88 months (range, 10–132 mo). There was one asymptomatic radiological recurrence. No seizures occurred after surgery. Conclusion: The results of this study support the role of endoscopic resection in the treatment of patients with colloid cysts as a safe and effective modality. In some cases, conversion to an open procedure may be required. Additional follow-up will be required to continue to address the duration of lesion-free survival.

Endoscopic Fenestration of Cavum Septum Pellucidum Cysts to the Third Ventricle: Technical Note

2020 ◽  
Vol 19 (4) ◽  
pp. E434-E439
Author(s):  
Alexandre Simonin ◽  
Omar Bangash ◽  
Arjun S Chandran ◽  
Erik Uvelius ◽  
Christopher Lind
Keyword(s):  
Surgical Procedure ◽  
Clinical Presentation ◽  
Third Ventricle ◽  
Technical Note ◽  
Septum Pellucidum ◽  
Imaging Studies ◽  
Foramen Of Monro ◽  
Cavum Septum Pellucidum ◽  
The Third ◽  
Endoscopic Fenestration

Abstract BACKGROUND AND IMPORTANCE Cavum septum pellucidum (CSP) and cavum vergae (CV) cysts are common incidental findings on imaging studies. However, they may rarely present with symptoms related to the obstruction of the foramen of Monro by the cyst leaflets. There is no consensus regarding the management of symptomatic CSP and CV cysts. We present an original transcavum interforniceal endoscopic fenestration technique. The step-by-step surgical procedure and two illustrative cases are presented. CLINICAL PRESENTATION A 31-yr-old male and a 24-yr-old woman presented with symptomatic CSP and CV cysts. For both patients, neuronavigation was used to plan the procedure. An endoscope was introduced into the cyst through a right frontal burr-hole. After an examination of the endoscopic anatomy, a communication between the cyst and the third ventricle was performed using an endoscopic forceps. In both cases, directly after the fenestration, cerebrospinal fluid (CSF) passed through the communication, and the collapse of the cyst was appreciated. Symptoms were relieved in both patients, and neuropsychological assessment improved. Postoperative imaging showed a reduction in the cyst bulge, and patent foramen of Monro. CONCLUSION Endoscopic fenestration of CSP and CV cysts to the third ventricle through an interforniceal navigated approach is a feasible and efficient surgical procedure. Theoretical advantages include a single tract through noneloquent brain, a perpendicular trajectory to the membrane for fenestration, and a large CSF space beyond the fenestration point.

Hypothalamic Hamartoma in a Dog

1977 ◽  
Vol 14 (2) ◽  
pp. 138-145 ◽  
Author(s):  
R. W. Cook
Keyword(s):  
Cerebrospinal Fluid ◽  
Third Ventricle ◽  
Fluid Pressure ◽  
Hypothalamic Hamartoma ◽  
Tuber Cinereum ◽  
Mammillary Bodies ◽  
Spongiform Change ◽  
The Third ◽  
The Brain ◽  
Rostral Part

A 10-month-old female, Wire-haired Pointing Griffon dog had a hamartoma of the hypothalamus. Episodes of sudden flaccid collapse had increased in frequency and duration for 7 months. Cerebrospinal fluid pressure was normal. A flat, pedunculated mass, 2.5×3.0×0.9 cm, covered the brain stem between the pituitary gland and pons. Its 1.2-cm-diameter connection to the hypothalamus obliterated the mammillary bodies and extended to the tuber cinereum, distorting the hypothalamus and displacing the third ventricle which also divided the rostral part of the mass. The tissue of the hamartoma resembled gray matter with bullous cytoplasmic vacuolation of many neurons, spongiform change, gemistocytosis and microscopic foci of calcification.

Neurological complications after gamma-knife radiosurgery for hypothalamic hamartoma

2016 ◽  
Vol 20 (5) ◽  
pp. 745-749 ◽  
Author(s):  
Laura Butragueño Laiseca ◽  
Niki Oikonomopoulou ◽  
María Concepción Miranda Herrero ◽  
Estíbaliz Barredo Valderrama ◽  
María Vázquez López ◽  
...  
Keyword(s):  
Gamma Knife ◽  
Gamma Knife Radiosurgery ◽  
Neurological Complications ◽  
Hypothalamic Hamartoma

Seizure outcome and complications following hypothalamic hamartoma treatment in adults: endoscopic, open, and Gamma Knife procedures

2012 ◽  
Vol 117 (2) ◽  
pp. 255-261 ◽  
Author(s):  
Cornelia Drees ◽  
Kevin Chapman ◽  
Erin Prenger ◽  
Leslie Baxter ◽  
Rama Maganti ◽  
...  
Keyword(s):  
Mental Retardation ◽  
Weight Gain ◽  
Gamma Knife ◽  
Third Ventricle ◽  
Intractable Epilepsy ◽  
Adult Patients ◽  
Neurological Deficits ◽  
Hypothalamic Hamartoma ◽  
Seizure Outcome ◽  
Seizure Freedom

Object This study aimed at identifying outcomes with respect to seizures, morbidity, and mortality in adult patients undergoing resective or Gamma Knife surgery (GKS) to treat intractable epilepsy associated with hypothalamic hamartoma (HH). Methods Adult patients undergoing surgical treatment for HH-related epilepsy were prospectively monitored at a single center for complications and seizure outcome by using a proprietary database. Preintervention and postintervention data for patients 18 years of age and older, and with at least 1 year of follow-up, were analyzed, with specific attention to seizure control, complications, hormonal status, and death. Results Forty adult patients were found in the database (21 were women). The median HH volume was 0.54 cm3. In 70% of patients, it was located inside the third ventricle, attached unilaterally and vertically to the hypothalamus (Delalande Type II). Most patients (26) underwent an endoscopic resection, 10 patients had a transcallosal or other type of open (pterional or orbitozygomatic) resection, and 4 patients chose GKS. Twenty-nine percent became seizure free in the long term, and overall a majority of patients (55%) reported at least > 90% seizure improvement. Only 3 patients were ultimately able to discontinue anticonvulsants, whereas most patients were taking an average of 2 antiepileptic drugs pre- and postoperatively. The only factor significantly correlated with seizure-free outcome was the absence of mental retardation. The HH volume, HH type, and amount of resection or disconnection were not correlated to seizure freedom. A total of 4 patients (10%) died, 2 immediately after surgery and 2 later. All of them had undergone a resection, as opposed to GKS, and still had seizures. Postoperatively, persistent neurological deficits were seen in 1 patient; 34% of patients had mild hormonal problems; and 59% experienced weight gain of at least 6.8 kg (average gain 12.7 kg). Conclusions Surgical or GKS procedures in adults with HH provided seizure freedom in one-third of patients. The only significant favorable prognostic factor was the absence of mental retardation. The overall mortality rate was high, at 10%. Other important morbidities were persistent hormonal disturbances and weight gain.

Hyponatremia following endoscopic third ventriculostomy: a report of 5 cases and analysis of risk factors

2012 ◽  
Vol 10 (1) ◽  
pp. 39-43 ◽  
Author(s):  
Shih-Shan Lang ◽  
Joel A. Bauman ◽  
Michael W. Aversano ◽  
Matthew R. Sanborn ◽  
Arastoo Vossough ◽  
...  
Keyword(s):  
Risk Factors ◽  
Endoscopic Third Ventriculostomy ◽  
Third Ventricle ◽  
Aqueductal Stenosis ◽  
Third Ventriculostomy ◽  
Fogarty Catheter ◽  
Mr Images ◽  
Saline Irrigation ◽  
Pituitary Dysfunction ◽  
Tectal Glioma

Object Electrolyte and endocrinological complications of endoscopic third ventriculostomy (ETV) are infrequent but serious events, likely due to transient hypothalamic-pituitary dysfunction. While the incidence of diabetes insipidus is relatively well known, hyponatremia is not often reported. The authors report on a series of 5 patients with post-ETV hyponatremia. Methods The records of patients undergoing ETV between 2008 and 2010 were reviewed. All ETVs were performed with a rigid neuroendoscope via a frontal bur hole, standard third ventricle floor blunt perforation, Fogarty catheter dilation, and intermittent normal saline irrigation. Postoperative MR images were evaluated for endoscope tract injury as well as the trajectory from the bur hole center to the fenestration site. Results Thirty-two patients (20 male and 12 female) underwent ETV. Their median age was 6 years (range 3 weeks–28 years). Hydrocephalus was most commonly due to nontumoral aqueductal stenosis (43%), nontectal tumor (25%), or tectal glioma (13%). Five patients (16%) had multicystic/loculated hydrocephalus. Five patients (16%) developed hyponatremia between 1 and 8 days following ETV, including 2 patients with seizures (1 of whom was still hospitalized at the time of the seizure and 1 of whom was readmitted as a result of the seizure) and 3 patients who were readmitted because of decline in their condition following routine discharge. No hypothalamic injuries were noted on imaging. Univariate risk factors consisted of age of 2 years or less (p = 0.02), presence of cystic lesions (p = 0.02), and ETV trajectory angle 10° or more from perpendicular (p = 0.001). Conclusions Endoscopic third ventriculostomy is a well-tolerated procedure but can result in serious complications. Hyponatremia is rare and may be more likely in younger patients or those with cystic loculations. Patients with altered craniometry may be at particular risk with a rigid endoscopic approach requiring greater manipulation of subforniceal or hypothalamic structures.

Gamma Knife Radiosurgery for Refractory Epilepsy Caused by Hypothalamic Hamartomas

2006 ◽  
Vol 84 (2-3) ◽  
pp. 82-87 ◽  
Author(s):  
David Mathieu ◽  
Douglas Kondziolka ◽  
Ajay Niranjan ◽  
John Flickinger ◽  
L. Dade Lunsford
Keyword(s):  
Gamma Knife ◽  
Refractory Epilepsy ◽  
Gamma Knife Radiosurgery ◽  
Hypothalamic Hamartomas

The relationship between magnetic resonance imaging findings and clinical manifestations of hypothalamic hamartoma

1999 ◽  
Vol 91 (2) ◽  
pp. 212-220 ◽  
Author(s):  
Kazunori Arita ◽  
Fusao Ikawa ◽  
Kaoru Kurisu ◽  
Masayuki Sumida ◽  
Kunyu Harada ◽  
...  
Keyword(s):  
Mental Retardation ◽  
Magnetic Resonance ◽  
Precocious Puberty ◽  
Third Ventricle ◽  
Clinical Manifestations ◽  
Hypothalamic Hamartoma ◽  
Content Type ◽  
The Third ◽  
The Relationship ◽  
Fine Print

Object. Hypothalamic hamartoma is generally diagnosed based on its magnetic resonance (MR) imaging characteristics and the patient's clinical symptoms, but the relationship between the neuroradiological findings and clinical presentation has never been fully investigated. In this retrospective study the authors sought to determine this relationship.Methods. The authors classified 11 cases of hypothalamic hamartoma into two categories based on the MR findings. Seven cases were the “parahypothalamic type,” in which the hamartoma is only attached to the floor of the third ventricle or suspended from the floor by a peduncle. Four cases were the “intrahypothalamic type,” in which the hamartoma involved or was enveloped by the hypothalamus and the tumor distorted the third ventricle.Six patients with the parahypothalamic type exhibited precocious puberty, which was controlled by a luteinizing hormone—releasing hormone analog, and one patient was asymptomatic. No seizures or mental retardation were observed in this group. All patients with the intrahypothalamic type had medically intractable seizures, and precocious puberty was seen in one. Severe mental retardation and behavioral disorders including aggressiveness were seen in two patients. The seizures were controlled in only one patient, in whom stereotactically targeted irradiation of the lesion was performed.This topology/symptom relationship was reconfirmed in a review of 61 reported cases of hamartoma, in which the MR findings were clearly described. The parahypothalamic type is generally associated with precocious puberty but is unaccompanied by seizures or developmental delay, whereas the intrahypothalamic type is generally associated with seizures. Two thirds of patients with the latter experience developmental delays, and half also exhibit precocious puberty.Conclusions. Classification of hypothalamic hamartomas into these two categories based on MR findings resulted in a clear correlation between symptoms and the subsequent clinical course.

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