neurosurgeryНейрохирургияRussian journal of neurosurgery1683-32952587-7569Издательский дом "МедИНК"10.17650/1683-3295-2019-21-1-72-82neurosurgery-688Research ArticleНАБЛЮДЕНИЕ ИЗ ПРАКТИКИFROM PRACTICEТрансназальное эндоскопическое удаление гипоталамической гамартомы (наблюдения из практики)Transnasal endoscopic removal of hypothalamic hamartoma (case reports)https://orcid.org/0000-0002-9575-4520ГригорьевА. Ю.GrigorievA. Yu.https://orcid.org/0000-0002-6911-0975ТрифоновИ. С.TrifonovI. S.dr.trifonov@mail.ruhttps://orcid.org/0000-0001-5026-0060СинкинМ. В.SinkinM. V.https://orcid.org/0000-0001-8207-7180ГригорьеваЕ. В.GrigorievaE. V.https://orcid.org/0000-0001-7371-7182КаймовскийИ. Л.KaimovskiyI. L.https://orcid.org/0000-0001-7045-7223ШишкинаЛ. В.ShishkinaL. V.https://orcid.org/0000-0001-5256-0905КрыловВ. В.KrylovV. V.ФГБОУ ВО «Московский государственный медико-стоматологический университет им. А.И. Евдокимова» Минздрава РоссииРоссияA.I. Evdokimov Moscow State University of Medicine and Dentistry, Ministry of Health of RussiaRussian FederationГБУЗ «Научно-исследовательский институт скорой помощи им. Н.В. Склифосовского Департамента здравоохранения г. Москвы»РоссияN.V. Sklifosovsky Research Institute for Emergency Medicine, Moscow Healthcare DepartmentRussian FederationГБУЗ «Городская клиническая больница им. В.М. Буянова Департамента здравоохранения г. Москвы»РоссияV.M. Buyanov City Clinical Hospital, Moscow Health DepartmentRussian FederationФГАУ «Национальный медицинский исследовательский центр нейрохирургии им. Н.Н. Бурденко» Минздрава РоссииРоссияN.N. Burdenko National Medical Research Center of Neurosurgery, Ministry of Health of RussiaRussian Federation2019110420192117282Copyright © Григорьев А.Ю., Трифонов И.С., Синкин М.В., Григорьева Е.В., Каймовский И.Л., Шишкина Л.В., Крылов В.В., 20192019Григорьев А.Ю., Трифонов И.С., Синкин М.В., Григорьева Е.В., Каймовский И.Л., Шишкина Л.В., Крылов В.В.Grigoriev A.Y., Trifonov I.S., Sinkin M.V., Grigorieva E.V., Kaimovskiy I.L., Shishkina L.V., Krylov V.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.therjn.com/jour/article/view/688

Цель исследования – описать 2 клинических случая транссфеноидального эндоскопического удаления гипоталамических гамартом (ГГ). Данный метод лечения ранее не рассматривался в российских и иностранных публикациях. Материалы и методы. Пациент Р., 16 лет, поступил с жалобами на эпилептические приступы частотой 1 раз в 5–6 дней. Длительность заболевания составляла 9 лет. Пациентка М., 23 лет, поступила с жалобами на эпилептические приступы частотой 1 раз в неделю. Длительность заболевания составляла 16 лет. Результаты. У пациента Р. по данным магнитно-резонансной томографии головного мозга диагностирована ГГ размерами 1,5 × 1,4 × 1,4 см, фокальная кортикальная дисплазия правой затылочной доли. При проведении 3-суточного видеомониторинга со скальповой электроэнцефалографией зарегистрировано 3 вторично-генерализованных сложных парциальных приступа. Выполнено транссфеноидальное эндоскопическое удаление ГГ. В течение 18 мес после операции на фоне приема прежних доз противосудорожных препаратов эпилептических приступов не было. У пациентки М. при магнитно-резонансной томографии головного мозга выявлена ГГ размерами 2,44 × 2,79 × 2,68 см. При проведении 4-суточного видеомониторинга со скальповой электроэнцефалографией зарегистрировано 2 вторично-генерализованных сложных парциальных приступа. Выполнено транссфеноидальное удаление ГГ. В течение 8 мес после операции приступов не было. Заключение. Данные клинические наблюдения продемонстрировали эффективность и безопасность трансназального удаления ГГ у пациентов с фармакорезистентными формами эпилепсии. Радикальное удаление ГГ позволяет достичь полного контроля над заболеванием, ранее устойчивым к фармакотерапии.

The study objective is to report 2 cases of endoscopic transsphenoidal removal of hypothalamic hamartomas (HH). This surgical method has not been previously considered in both Russian and foreign publications. Materials and methods. A 16-year-old male patient (R.) was admitted to hospital with complaints of epileptic seizures occurring once every 5–6 days; the disease duration was 9 years. A 23-year-old female patient (M.) was also admitted to hospital with complaints of epileptic seizures occurring once a week; the disease duration was 16 years. Results. Magnetic resonance imaging of the brain of patient R. revealed a HH (1.5 cm × 1.4 cm × 1.4 cm) and focal cortical dysplasia in the right occipital lobe. During a 3-day video electroencephalogram monitoring, we registered 3 secondary generalized complex partial seizures. Patient R. underwent endoscopic transsphenoidal removal of the HH. After surgery, he experienced no epileptic seizures during the next 18 months, even though he continued to receive the same doses of antiepileptic drugs. Magnetic resonance imaging of the brain of patient M. demonstrated a HH (2.44 cm × 2.79 cm × 2.68 cm). During a 4-day video electroencephalogram monitoring, we registered 2 secondary generalized complex partial seizures. The patient underwent transsphenoidal removal of the HH. During the next 8 months, the patient experienced no seizures. Conclusion. Our results suggest that transnasal removal of HH is a highly effective and safe procedure for patients with drug-resistant epilepsy. Surgical removal of HHs ensures effective control of the disease, which was previously resistant to pharmacotherapy.

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The authors declare that there are no conflicts of interest present.