Hypothalamic hamartoma causing gelastic seizures treated with stereotactic radiofrequency thermocoagulation.

PURPOSE To present a case of small hypothalamic hamartoma (HH) causing gelastic seizures and treated with stereotactic radiofrequency thermocoagulation. CASE REPORT A 22-year-old man presented with intractable gelastic seizures and focal seizures refractory to medical treatment. Magnetic resonance imaging showed a 6 mm x 6 mm x 7 mm sessile intraventricular HH. Under local anesthesia, four intra-hamartoma lesions were made via stereotactic radiofrequency thermocoagulation using a depth electrode for recording and stimulation. RESULTS Transient central hyperthermia, hypertension, and tachycardia were observed during the coagulation procedure. Intra-hamartoma spikes and slow waves were identified on depth electrode recordings. No gelastic seizure was induced by deep stimulation. The patient was seizure-free during the 12-month follow up and no permanent surgical complications occurred. CONCLUSION Stereotactic radiofrequency thermocoagulation may be an effective and safe treatment option in selected cases of hypothalamic hamartoma with gelastic seizures.