Surgical Treatment of Hypothalamic Hamartoma Causing Refractory Epilepsy: A Systematic Review

Background: Hypothalamic hamartomas (HHs) are a known cause of refractory focal epilepsy. Advancement in microsurgical techniques and introduction of stereotactic ablative methods has led to improved complication rates but the effect on seizure control is still to be determined. In this systematic review, we present a thorough analysis of published literature on the outcomes of various surgical treatments of hypothalamic hamartomas for refractory epilepsy. Methods: Literature search using the MedLine, SCOPUS, and Cochrane databases was conducted. All English language studies describing surgical treatment of hypothalamic hamartoma with refractory epilepsy, with minimum three patients and a follow-up of at least one year were identified. Results: An initial selection of 55 studies were reduced to 41 after combining studies from the same groups, 14 Open, 4 Endoscopic, 8 GKRS, 9 LITT, and 6 RF-TC studies were included. From a total of 832 patients. 209 underwent Open (25.1%), 80 Endoscopic (9.6%), 124 GKRS (14.9%), 229 LITT (27.5%), and 190 RF-TC (22.8%). Engel I or ILAE 1,2 achieved in: Open 115 (55.0%), Endoscopic 38 (47.5%), GKRS 49 (39.5%), LITT 176 (76.9%), RF-TC 128 (67.4%). Invasive surgeries (Open and Endoscopic) had a higher incidence of neurological complications (27.0%) than ablative surgeries (GKRS, LITT, RF-TC) (7.2%). Reoperation rates were higher for ablative surgeries (23.8%) than invasive surgeries (9.0%). Conclusion: Surgical treatment of hypothalamic hamartoma causing refractory epilepsy is effective. RF-TC and LITT surgery types have the highest Engel Class I outcomes and ablative surgeries have a lower neurological complication profile compared to open and endoscopic approaches.