open access

Vol 44, No 6 (2010)
Submitted: 2010-03-28
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Rare primary tumours of the hypothalamus in adults: clinical course and surgical treatment

Krzysztof Majchrzak, Grażyna Bierzyñska-Macyszyn, Barbara Bobek-Billewicz, Henryk Majchrzak, Piotr Ładziński
DOI: 10.1016/S0028-3843(14)60151-1
·
Neurol Neurochir Pol 2010;44(6):546-553.

open access

Vol 44, No 6 (2010)
Submitted: 2010-03-28

Abstract

Background and purpose

The paper presents the operative technique and the results of treatment of adult patients with primary tumours of the hypothalamus, including rare ones. The aim of the study was to show the possibility of safe surgical treatment of rare tumours of the hypothalamus through a bifrontal basal interhemispheric trans-lamina terminalis approach.

Material and methods

Five patients with tumours of the hypothalamus were operated on in the Neurosurgical Clinic in Sosnowiec between 1990 and 2008. There were 2 patients with craniopharyngiomas located exclusively in the third ventricle, and single patients with gemistocytic astrocytoma, Langerhans cell histiocytosis X and hamartoma of the hypothalamus each. The patients were treated surgically with a bifrontal basal interhemispheric trans-lamina terminalis approach. In two cases, the neuronavigation system with the use of tractography (DTI) was used to determine the location of the lamina terminalis, the posterior surface of the optic chiasm and the optic tracts.

Results

All lesions were resected totally, except for partially resected hamartoma of the hypothalamus. The most common postoperative complication was diabetes insipidus, which was transient in two cases. A long-lasting follow-up of all the patients operated on did not reveal regrowth of the lesion.

Conclusions

The bifrontal basal interhemispheric trans-lamina terminalis approach allows for radical resection of primary tumours of the hypothalamus while avoiding serious postoperative deficits. This approach enabled the preservation of the olfactory bulb and tract and prevented damage of the frontal lobes. The use of DTI helped to establish the location and borders of the lamina terminalis, to establish the posterior surface of the optic chiasm and the optic tracts, and to save the anterior and lateral wall of the hypothalamus.

Abstract

Background and purpose

The paper presents the operative technique and the results of treatment of adult patients with primary tumours of the hypothalamus, including rare ones. The aim of the study was to show the possibility of safe surgical treatment of rare tumours of the hypothalamus through a bifrontal basal interhemispheric trans-lamina terminalis approach.

Material and methods

Five patients with tumours of the hypothalamus were operated on in the Neurosurgical Clinic in Sosnowiec between 1990 and 2008. There were 2 patients with craniopharyngiomas located exclusively in the third ventricle, and single patients with gemistocytic astrocytoma, Langerhans cell histiocytosis X and hamartoma of the hypothalamus each. The patients were treated surgically with a bifrontal basal interhemispheric trans-lamina terminalis approach. In two cases, the neuronavigation system with the use of tractography (DTI) was used to determine the location of the lamina terminalis, the posterior surface of the optic chiasm and the optic tracts.

Results

All lesions were resected totally, except for partially resected hamartoma of the hypothalamus. The most common postoperative complication was diabetes insipidus, which was transient in two cases. A long-lasting follow-up of all the patients operated on did not reveal regrowth of the lesion.

Conclusions

The bifrontal basal interhemispheric trans-lamina terminalis approach allows for radical resection of primary tumours of the hypothalamus while avoiding serious postoperative deficits. This approach enabled the preservation of the olfactory bulb and tract and prevented damage of the frontal lobes. The use of DTI helped to establish the location and borders of the lamina terminalis, to establish the posterior surface of the optic chiasm and the optic tracts, and to save the anterior and lateral wall of the hypothalamus.

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Keywords

primary hypothalamic tumours, clinical signs, surgical treatment, bifrontal basal interhemispheric trans-lamina terminalis approach, DTI, outcome

About this article
Title

Rare primary tumours of the hypothalamus in adults: clinical course and surgical treatment

Journal

Neurologia i Neurochirurgia Polska

Issue

Vol 44, No 6 (2010)

Pages

546-553

DOI

10.1016/S0028-3843(14)60151-1

Bibliographic record

Neurol Neurochir Pol 2010;44(6):546-553.

Keywords

primary hypothalamic tumours
clinical signs
surgical treatment
bifrontal basal interhemispheric trans-lamina terminalis approach
DTI
outcome

Authors

Krzysztof Majchrzak
Grażyna Bierzyñska-Macyszyn
Barbara Bobek-Billewicz
Henryk Majchrzak
Piotr Ładziński

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