Intraventricular endoscopic surgery for pediatric hypothalamic hamartomas: surgical series and literature meta-analysis

Abstract

Objective: Intraventricular endoscopic procedures represent a valuable option for the treatment of hypothalamic hamartomas (HH). Thulium-laser disconnection has been proposed as an alternative to monopolar disconnection techniques. We aim to present our consecutive surgical series and we performed a meta-analysis to provide an overall summary of the relevant literature.

Methods: We conducted a retrospective review of pediatric cases treated from 2016 to 2023. A description of the surgical procedures is provided, along with surgical outcomes and complications. We conducted a meta-analysis by selecting studies including pediatric patients with HH undergoing an endoscopic treatment and detailing epilepsy outcomes and postoperative complications.

Results: Fifteen pediatric patients were operated in the aforementioned period: 13 had a thulium laser disconnection (87%). Six patients were seizure free (40%) and 9 had improved seizures' control (60%) at last follow-up. No permanent postoperative complications were reported. We included 8 articles and our series in the meta-analysis, encompassing 302 patients undergoing endoscopic surgeries. Endoscopic procedures were performed in 82% of cases and disconnection accounted for 75% of endoscopic procedures. Engel class I was reported in 52% of patients, while Engel Class I to II was obtained in 69% of cases at last follow-up (median 22.5 months). Complication rates were around 5%, mainly including memory deficits and thalamic infarcts.

Conclusion: Endoscopic procedures for HH are a safe option for children, as they demonstrate a high level of success in controlling epilepsy and low rates of complications. Thulium-laser disconnection could represent an attractive tool for disconnection procedures. Larger studies could be valuable to validate this technique in the pediatric population.

Keywords: disconnection; endoscopic neurosurgery; epilepsy surgery; hypothalamic hamartoma; pediatric; seizure outcome.