Hypothalamic hamartoma

Surgery

Precocious puberty

Epilepsy surgery

Psychiatry

Functional magnetic resonance imaging

Gelastic seizure

Radiology

Epilepsy

Internal medicine

Hormone

Medicine

Nuclear medicine

Hamartoma

Magnetic resonance imaging

Pathology

Epilepsia

Summary Objective The purpose of this study is to investigate the outcomes of epilepsy surgery targeting the subcentimeter‐sized resting state functional magnetic resonance imaging (rs‐fMRI) epileptogenic onset zone (EZ) in hypothalamic hamartoma (HH). Methods Fifty‐one children with HH ‐related intractable epilepsy received anatomical MRI ‐guided stereotactic laser ablation (SLA) procedures. Fifteen of these children were control subjects ( CS ) not guided by rs‐ fMRI . Thirty‐six had been preoperatively guided by rs‐ fMRI ( RS ) to determine EZ s, which were subsequently targeted by SLA . The primary outcome measure for the study was a predetermined goal of 30% reduction in seizure frequency and improvement in class I Engel outcomes 1 year postoperatively. Quantitative and qualitative volumetric analyses of total HH and ablated tissue were also assessed. Results In the RS group, the EZ target within the HH was ablated with high accuracy (&gt;87.5% of target ablated in 83% of subjects). There was no difference between the groups in percentage of ablated hamartoma volume ( P = 0.137). Overall seizure reduction was higher in the rs‐ fMRI group: 85% RS versus 49% CS ( P = 0.0006, adjusted). The Engel Epilepsy Surgery Outcome Scale demonstrated significant differences in those with freedom from disabling seizures (class I), 92% RS versus 47% CS , a 45% improvement ( P = 0.001). Compared to prior studies, there was improvement in class I outcomes (92% vs 76%‐81%). No postoperative morbidity or mortality occurred. Significance For the first time, surgical SLA targeting of subcentimeter‐sized EZ s, located by rs‐ fMRI , guided surgery for intractable epilepsy. Our outcomes demonstrated the highest seizure freedom rate without surgical complications and are a significant improvement over prior reports. The approach improved freedom from seizures by 45% compared to conventional ablation, regardless of hamartoma size or anatomical classification. This technique showed the same or reduced morbidity (0%) compared to recent non–rs‐ fMRI ‐guided SLA studies with as high as 20% permanent significant morbidity.

Subcentimeter epilepsy surgery targets by resting state functional magnetic resonance imaging can improve outcomes in hypothalamic hamartoma