Robotic Guided Radiofrequency Ablation Of Hypothalamic Hamartomas

Abstract

Introduction: Hypothalmic hamartomas (HH) are benign masses, often associated with drug refractory epilepsy. Open surgery is fraught with high risk of morbidity and a higher failure rate. Robotic guided Radiofrequency ablation (RF) ablation is a safe and effective method.  Material & Methods: We use robotic guided (ROSA) RF ablation. Multiple trajectories are planned using ROSA guidance and holes are created in the skull pre-coronally, using twist drill. The RF probe is then inserted into the planned trajectory and confirmed with the help of introp CT (O-arm) by superimposing with the planned trajectories on MRI before proceding with lesioning. Multiple lesions are created using multiple trajectories, leading to ‘ablative disconnection’ using a RF pulse generator for 60 secs at a temperature of 740C. Results: A total of 19 patients were subjected to this procedure. Mean age: 4.3 (±3.91) years. Mean IQ: 37±5.7. Mean lesion numbers: 3.67 (± 1.75), and mean number of trajectories were 5 (±1.32). Follow-up period ranged from 6 to 24 months (mean: 13 months). The grades of HH were:  grade I- 3, grade II- 2, grade III- 11 patients and grade IV- 2 (Delalande’s). There was no mortality, and morbidity (except transient sodium imbalance in 1). Three patients had repeat surgeries, of which one was operated thrice and the remaining two were operated twice for seizure recurrence. Fifteen patients had good outcomes including those after the repeat surgery (ILAE class I) and four patient had class II outcome following the second surgery and Class I outcome with repeat surgery. Conclusion:  Robotic guided RF ablation for HH seems to be a safe and effective procedure. The safety profile remains high even with repeat surgeries.