Rare primary tumours of the hypothalamus in adults: clinical course and surgical treatment
- Department of Neurosurgery in Sosnowiec, Medical University of Silesia in Katowice, Poland
- Section of Pathomorphology, Medical University of Silesia in Katowice, Poland
- Radiodiagnostics Department, Comprehensive Cancer Centre, Maria Sklodowska-Curie, Memorial Institute Branch, Gliwice, Poland
open access
Abstract
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 methodsFive 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.
ResultsAll 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.
ConclusionsThe 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
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 methodsFive 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.
ResultsAll 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.
ConclusionsThe 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.
Keywords
primary hypothalamic tumours, clinical signs, surgical treatment, bifrontal basal interhemispheric trans-lamina terminalis approach, DTI, outcome
Title
Rare primary tumours of the hypothalamus in adults: clinical course and surgical treatment
Journal
Neurologia i Neurochirurgia Polska
Issue
Pages
546-553
Page views
348
Article views/downloads
681
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