Stereotactic Radiosurgery in the Management of Intractable Seizure Due to Hypothalamic Hamartoma

The occurrence of severe seizure is almost always present in hypothalamic hamartomas (HH) cases and surgery is an option to control the condition. Stereotactic radiosurgery (SRS) is among of alternative treatments. Our objective is to provide current evidence for seizure treatment with SRS in HHs patients. From EuroPMC, PubMed, ScienceDirect and the Cochrane Library, each author carried out literature searches on seizure treatment for HH using SRS between 1971 and 2021 using the following terms: stereotactic radiosurgery, radiosurgery, CyberKnife, Gamma Knife, linear accelerator, radiotherapy and hypothalamic hamartoma. We included any patients with seizure onset less than 18 years of age, regardless of age when SRS was performed. This systematic review included 17 out of 31 studies, three of which were observational studies. The study included 131 individuals, with a median age of onset of 7.4 years old and a male-to-female ratio of 34.3% (n=45). The isodose at the margin was 19 Gy. The median lesion volume at the time of diagnosis was 0.8 mL (0.1 – 48.3 mL). The median follow-up after SRS was 34.3 months (3 – 77 months). Only eight of the 90 HHs had a change in MR and 12 patients, SRS had no effect on the seizure frequency. The authors concluded that SRS is beneficial for the treatment of HH. However, the authors could not deny that current evidence is too early to construct a systematic review and a more prospective study design is required.