MRgFUS disconnection surgery for hypothalamic hamartoma-related epilepsy: case report and literature review.

IF 2.7 4区医学 Q2 CLINICAL NEUROLOGY

Neurological Sciences Pub Date : 2025-03-01 Epub Date: 2024-12-28 DOI:10.1007/s10072-024-07946-2

Giuseppe K Ricciardi, Fabio Paio, Cecilia Zivelonghi, Michele Longhi, Giorgia Bulgarelli, Micaela Tagliamonte, Paolo M Polloniato, Elisa Mantovani, Monica Ferlisi, Antonio Nicolato, Stefania Montemezzi, Michele Tinazzi, Bruno Bonetti, Francesco Sala, Tiziano Zanoni, Stefano Tamburin

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引用次数: 0

Abstract

Background: Drug-resistant epilepsy (DRE) secondary to hypothalamic hamartoma (HH) often requires surgical resection or stereotactic radiosurgery, which frequently fail to provide satisfactory outcomes and are associated with severe side effects. Magnetic resonance-guided focused ultrasound (MRgFUS) may represent a minimally invasive surgical approach to HH by offering precise thermal ablation of sub-millimetric brain targets while sparing surrounding structures.

Methods: We present the case of a 19-year-old man with HH-associated DRE, who was successfully treated with MRgFUS. The procedure resulted in effective ablation of the hypothalamic interface of the HH, disconnecting the epileptogenic lesion from the surrounding brain tissue. We also reviewed the literature on MRgFUS for DRE.

Results: The patient experienced a complete resolution of seizures and significant improvements in social and occupational functioning over an 18-month follow-up period. No neurological, cognitive, or endocrinological adverse effects were observed.

Conclusion: Our case report and literature review suggest that MRgFUS may achieve adequate seizure control in DRE associated with HH without adverse effects. While MRgFUS shows promise for other forms of DRE, data remain preliminary, and some safety concerns persist. Further studies with long-term follow-up are warranted to better support the use of MRgFUS in DRE.

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MRgFUS断连术治疗下丘脑错构瘤相关性癫痫1例报告并文献复习。

背景：下丘脑错构瘤（HH）继发的耐药癫痫（DRE）通常需要手术切除或立体定向放射治疗，但往往不能提供满意的结果，并伴有严重的副作用。磁共振引导聚焦超声（MRgFUS）可以提供精确的亚毫米级脑目标热消融，同时保留周围结构，这可能是HH的微创手术方法。方法：我们报告了一名19岁男性hh相关性DRE的病例，他成功地接受了MRgFUS治疗。该手术有效地消融了HH的下丘脑界面，断开了癫痫性病变与周围脑组织的连接。我们也回顾了MRgFUS治疗DRE的文献。结果：在18个月的随访期间，患者经历了癫痫发作的完全解决和社会和职业功能的显着改善。没有观察到神经、认知或内分泌方面的不良反应。结论：我们的病例报告和文献回顾表明，MRgFUS可以在HH相关的DRE中实现充分的癫痫控制，而不会产生不良反应。虽然MRgFUS对其他形式的DRE显示出了希望，但数据仍然是初步的，一些安全问题仍然存在。为了更好地支持MRgFUS在DRE中的应用，需要进一步的长期随访研究。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Neurological Sciences 医学-临床神经学

CiteScore

6.10

自引率

3.00%

发文量

743

审稿时长

4 months

期刊介绍： Neurological Sciences is intended to provide a medium for the communication of results and ideas in the field of neuroscience. The journal welcomes contributions in both the basic and clinical aspects of the neurosciences. The official language of the journal is English. Reports are published in the form of original articles, short communications, editorials, reviews and letters to the editor. Original articles present the results of experimental or clinical studies in the neurosciences, while short communications are succinct reports permitting the rapid publication of novel results. Original contributions may be submitted for the special sections History of Neurology, Health Care and Neurological Digressions - a forum for cultural topics related to the neurosciences. The journal also publishes correspondence book reviews, meeting reports and announcements.