Neurological complications after gamma-knife radiosurgery for hypothalamic hamartoma

• Published in: European journal of paediatric neurology Vol. 20; no. 5; pp. 745 - 749
• Main Authors: Butragueño Laiseca, Laura, Oikonomopoulou, Niki, Miranda Herrero, María Concepción, Barredo Valderrama, Estíbaliz, Vázquez López, María, Jiménez de Domingo, Ana, Aguado del Hoyo, Alejandra, García-Leal, Roberto, Meiriño, Rosa M
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01-09-2016
• Subjects: Child; Consciousness Disorders - etiology; Epilepsy; Gamma-knife surgery; Gelastic seizures; Hamartoma - therapy; Humans; Hypothalamic Diseases - therapy; Hypothalamic hamartoma; Intractable epilepsy; Magnetic Resonance Imaging; Male; Neurology; Pediatrics; Radiosurgery; Radiosurgery - adverse effects; Seizures - etiology; Hypothalamic hamartoma; Gamma-knife surgery; Intractable epilepsy; Epilepsy; Radiosurgery; Gelastic seizures
• ISSN: 1090-3798; 1532-2130
• DOI: 10.1016/j.ejpn.2016.05.008

Abstract Background The Gamma-knife technique is a safe and effective option for the treatment of hypothalamic hamartomas that produce epileptic seizures refractory to medical treatment and/or serious behavioral disorders. After this type of radiosurgery, an adequate symptomatic control is normally achieved, with notable decrease or even disappearance of the seizures. Radiological changes, such as a decrease in the size of the tumor or adjacent edema secondary to non-necrotizing radioinduced inflammatory reaction are unusual consequences. Side effects and neurological complications are also rare events. Case presentation This report describes an unusual case of complete radiological resolution of a hypothalamic hamartoma as well as neurological complications after Gamma-knife surgery (receiving 13 Gy to the 85% isodose line, 1 cm3 of tumor volume) in a 8-year-old boy who suffered from severe refractory seizures. After radiosurgery, the patient experienced a notable improvement in his symptoms, achieving seizure cessation within 3 months. However, 4 months after the procedure he presented drowsiness, fever and decreased level of consciousness due to a direct effect on the hypothalamus with local and regional edema secondary to the radiosurgery that was performed. He was successfully treated with corticosteroids (with a total duration of 11 months), and twelve months after the surgery, complete disappearance of both the nodular lesion and the secondary edema was observed. The patient remains seizure-free in the last 16 months, with remarkable changes in his behavior. Conclusions The present case shows that complete radiological resolution of a hypothalamic hamartoma after Gamma-knife technique is unusual but possible, without long-term neurological consequences. Nevertheless, despite its low incidence, if a patient presents neurological symptoms, primarily during the first year after intervention, possible complications of this type of surgery must be taken into account.