Cranio-Orbitozygomatic Craniotomy for Resection of a Giant Hypothalamic Hamartoma: 2-Dimensional Operative Video.

Hypothalamic hamartomas (HHs) are rare lesions typically found in pediatric patients with gelastic seizures, precocious puberty, and rage attacks.(1) Treatment is surgical, ranging from less invasive approaches such as laser interstitial thermal therapy to open craniotomies for resection.(2-4) Orbitozygomatic craniotomies provide a skull base approach with excellent visualization of the inferior hypothalamic region and access to the third ventricle through the lamina terminalis with excellent postoperative cosmetic results.(4-6) The use of this approach for HH has been reported; however, details regarding the technical nuances of resection are sparse. Advances in intraoperative imaging using a surgical exoscope have also allowed for better visualization of the skull base anatomy and more ergonomic operations for the surgeon. Here, we report a case and provide a high-quality 2-dimensional exoscopic video detailing the use of an orbitozygomatic craniotomy for the resection of a giant HH, which had failed prior laser interstitial thermal therapy in a pediatric patient with persistent gelastic seizures and precocious puberty. Postoperative MRI demonstrated gross total resection of the lesion, and the patient was discharged at his neurological baseline. The patient remained seizure-free at the 6-month follow-up visit. The patient's family consented to participate in the surgery and the surgical video. The patient's family consented to the publication of his image.