Linear accelerator stereotactic radiosurgery for the treatment of gelastic seizures due to hypothalamic hamartoma

Michael T. Selch, A. Gorgulho, C. Mattozo, T. D. Solberg, C. Cabatan-Awang, A. A F DeSalles

Research output: Contribution to journalReview article

27 Scopus citations

Abstract

Purpose: There are reports of successful gamma-knife stereotactic radiosurgery (SRS) for the treatment of gelastic seizures associated with a hypothalamic hamartoma. The authors reviewed the results of linear accelerator (LINAC) radiosurgery for patients with medically refractory gelastic seizures due to a sessile hypothalamic hamartoma. Methods: Three patients with gelastic seizures received SRS between 2003 and 2004. All patients had associated partial complex and/or generalized seizures. One patient demonstrated aggressive behavior. Sessile hamartomas varying in diameter from 6 to 14 mm were identified by MRI. SRS was delivered to a single isocenter by a dedicated LINAC equipped with either a circular beam collimator or a micromultileaf collimator. Patients received 1500 to 1800 cGy prescribed at the 90 to 95% isodose line. Seizure outcome was scored according to Engel's classification. Results: Two patients became free of gelastic and partial complex/generalized seizures seven and nine months after radiosurgery. These patients remain free of seizures at 17 and 15 months, respectively, after treatment (Engle Class IA). One patient experienced a decline in gelastic seizure frequency nine months after treatment (Engle Class II) without significant reduction in aggressive behavior. Follow-up MRI demonstrated no change in the size or signal characteristics of any tumor. No patient developed post-treatment cranial neuropathy or hypothalamic-pituitary suppression. Conclusions: LINAC SRS represents a safe and effective therapeutic alternative for patients with medically refractory gelastic seizures due to unresectable hypothalamic hamartomas. Radiosurgery is associated with a latency of several months from treatment to reduction in seizure frequency. Further follow-up is required to establish the duration of seizure control following radiosurgery.

Original languageEnglish (US)
Pages (from-to)310-314
Number of pages5
JournalMinimally Invasive Neurosurgery
Volume48
Issue number5
DOIs
StatePublished - Oct 1 2005

Keywords

  • Gelastic seizure
  • Hypothalamic hamartoma
  • Stereotactic radiosurgery

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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    Selch, M. T., Gorgulho, A., Mattozo, C., Solberg, T. D., Cabatan-Awang, C., & DeSalles, A. A. F. (2005). Linear accelerator stereotactic radiosurgery for the treatment of gelastic seizures due to hypothalamic hamartoma. Minimally Invasive Neurosurgery, 48(5), 310-314. https://doi.org/10.1055/s-2005-915598