Raghu Samala¹*, Nikit Shah², Prasanthi Aripirala²

¹Department of Neurosurgery, Institute of Neurosciences, AIG Hospitals, Hyderabad, India
²Department of Pediatric Neurology, Rainbow Hospitals, Hyderabad, India

*Corresponding Author: Raghu Samala, Division of Epilepsy and Functional Neurosurgery, Department of Neurosurgery, Institute of Neurosciences, AIG Hospitals, Hyderabad, India.

Received: May 15, 2026; Published: June 30, 2026

Abstract

Hypothalamic hamartomas (HH) are rare, benign developmental malformations frequently associated with drug-refractory epilepsy, particularly gelastic seizures. Hypothalamic hamartomas attached to the hypothalamus, pose unique technical challenges for conventional surgical approaches due to deep-seated location and ill-defined hypothalamic interfaces. Robotic stereotactic radiofrequency (RF) disconnection offers submillimetric precision targeting and real-time intraoperative verification, representing an advanced minimally invasive alternative. We present a 3.5-year-old boy with 1.5 years of pharmacoresistant gelastic and focal seizures in whom MRI demonstrated a type 3B HH attached to the right hypothalamus. Presurgical evaluation including video- electroencephalography and endocrine profiling excluded significant hormone dysfunction except subclinical hypothyroidism. The planned robotic stereotactic RF disconnection utilizes CT-MRI fusion for trajectory planning, AutoGuide robot-assisted probe placement, and intraoperative O-arm CT confirmation, with 13 lesions through 4 trajectories at 74°C for 60 seconds per lesion. This case exemplifies the application of robot-assisted stereotactic RF disconnection for deep-seated, sessile intraventricular HH, balancing high seizure control rates with preservation of hypothalamic function and minimal permanent morbidity.

Keywords: Hypothalamic Hamartoma; Gelastic Seizures; Drug-Refractory Epilepsy; Robotic Stereotactic Radiofrequency Disconnection; Minimally Invasive Neurosurgery

References

1. Wilfong AA and Curry DJ. “Hypothalamic hamartomas: optimal approach to clinical evaluation and diagnosis”. Epilepsia 59 (2018): S3-S9.
2. Delalande O and Fohlen M. “Stereoelectroencephalography and endoscopic surgery for hypothalamic hamartomas”. Neurosurgery Focus2 (2010): E4.
3. Shirozu H., et al. “Electroclinical features of seizures associated with hypothalamic hamartomas”. Journal of Neurology, Neurosurgery and Psychiatry 4 (2005): 512-518.
4. Mullatti N., et al. “Pathophysiology of gelastic seizures in hypothalamic hamartoma: a review”. Epilepsy Behavior 97 (2019): 47-55.
5. Delalande O., et al. “Hypothalamic hamartomas: the stereotactic approach”. Neurosurgery 72(2013): 191-200.
6. Mullatti N and Selway RP. “Surgical approaches to hypothalamic hamartomas". Child's Nervous System1 (2023): 249-258.
7. Tandon V., et al. “Stereotactic radiofrequency thermocoagulation of hypothalamic hamartoma with robotic guidance”. World Neurosurgery 116 (2018): e1127-e1133.
8. Pati S., et al. “Real-time stereotactic laser ablation of hypothalamic hamartomas with robotic guidance”. Neurosurgery2 (2019): E347-E357.
9. Kameyama S., et al. “Long-term seizure outcomes after stereotactic radiofrequency thermocoagulation for hypothalamic hamartomas”. Epilepsia 11 (2016): 1789-1798.
10. Reinacher PC., et al. “Long-term outcomes of stereotactic radiofrequency ablation in hypothalamic hamartomas: a single-center experience”. Epilepsia 2 (2025): e1-e12.
11. Rampp S., et al. “Outcome of surgery for hypothalamic hamartoma-related epilepsy”. Neurology 12 (2024): e209026.
12. Shirozu H., et al. “Long-term seizure outcomes in patients with hypothalamic hamartoma treated by stereotactic radiofrequency thermocoagulation”. Epilepsia Open4 (2021): 648-658.
13. Li Y., et al. “Repeat stereotactic radiofrequency thermocoagulation in patients with hypothalamic hamartoma and seizure recurrence”. Epilepsia 1 (2020): 130-138.
14. Doddamani RS., et al. “Hypothalamic Hamartoma and Endocrinopathy: A Neurosurgeon's Perspective”. Neurology India 68 (2020): S146-S153.
15. Franzini A., et al. “Lesion-guided stereotactic radiofrequency thermocoagulation for palliative epilepsy surgery”. Stereotactic and Functional Neurosurgery1 (2016): 36-45.
16. Parrent AG. “Stereotactic radiofrequency ablation for hypothalamic hamartomas”. Epilepsia 45 (2004): 49-54.
17. Nariai H., et al. “Complications of MR-guided stereotactic laser ablation of hypothalamic hamartomas”. Epilepsia 3 (2021): e64-e72.
18. Pati S., et al. “Robotic stereotactic laser ablation for hypothalamic hamartomas”. Journal of Neurosurgery: Pediatrics3 (2019): 299-307.
19. Koutromanou E., et al. “Long-term seizure outcomes in patients with hypothalamic hamartoma-related epilepsy: systematic review and meta-analysis”. Epilepsia2 (2024): 445-458.
20. Procopio F., et al. “Endoscopic disconnection of hypothalamic hamartomas". Child's Nervous System4 (2022): 629-638.
21. Ng YT., et al. “Surgical outcomes in children with hypothalamic hamartomas: a comparison of transcallosal and transventricular endoscopic approaches”. Journal of Neurosurgery: Pediatrics6 (2019): 735-745.

Citation

Citation: Raghu Samala., et al. “Robotic Stereotactic Radiofrequency Disconnection of Hypothalamic Hamartoma for Drug-Refractory Epilepsy: An Emerging Technique". Acta Scientific Neurology 9.7 (2026): 06-12.

Copyright

Copyright: ©2026 Raghu Samala., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.