Hamartoma surgery: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{Hamartoma}} | {{Hamartoma}} | ||
{{CMG}}{{AE}}{{MV}} | {{CMG}} {{shyam}} {{AE}}{{MV}} | ||
==Overview== | ==Overview== | ||
[[Surgery]] is the mainstay of therapy for hamartomas. There are different [[anatomic]] approaches for different [[anatomic]] sites. | |||
==Surgery== | ==Surgery== | ||
===Pulmonary | ===Pulmonary Hamartoma=== | ||
Wedge resection is the | *[[Wedge resection (lung)|Wedge resection]] is the mainstay of therapy for patients with [[pulmonary]] hamartoma.<ref name="pmid18577258">{{cite journal |vauthors=Guo W, Zhao YP, Jiang YG, Wang RW, Ma Z |title=Surgical treatment and outcome of pulmonary hamartoma: a retrospective study of 20-year experience |journal=J. Exp. Clin. Cancer Res. |volume=27 |issue= |pages=8 |year=2008 |pmid=18577258 |pmc=2438336 |doi=10.1186/1756-9966-27-8 |url=}}</ref> | ||
*Other interventions, such as aggressive [[lobectomy]] or total [[pneumonectomy]] are only considered when the central intrapulmonary hamartoma is located in the deep part of [[pulmonary]] lobes or adhered severely to [[hilum]], and/or the distal lung tissue is nonfunctional. | |||
*Intraoperative [[frozen section]] is necessary to rule out [[malignancy]]. | |||
===Hypothalamic | ===Hypothalamic Hamartoma=== | ||
Hypothalamic hamartomas can be effectively treated with a variety of surgical approaches. The most | *[[Hypothalamic]] hamartomas can be effectively treated with a variety of surgical approaches. | ||
Other specific surgical options include; [[stereotactic]] thermocoagulation, [[gamma knife]] [[radiosurgery]], and physical resection by [[sphenoid bone|transsphenoidal]] microsurgery. | *The most effective approach is the [[magnetic resonance imaging]] (MRI)-guided stereotactic laser ablation (SLA). | ||
*This approach offers a a potentially safer, minimally invasive method with high efficacy for the [[hypothalamic]] hamartoma treatment.<ref name="pmid24328883">{{cite journal |vauthors=Wilfong AA, Curry DJ |title=Hypothalamic hamartomas: optimal approach to clinical evaluation and diagnosis |journal=Epilepsia |volume=54 Suppl 9 |issue= |pages=109–14 |year=2013 |pmid=24328883 |doi=10.1111/epi.12454 |url=}}</ref> | |||
*Other specific surgical options include; [[stereotactic]] thermocoagulation, [[gamma knife]] [[radiosurgery]], and physical resection by [[sphenoid bone|transsphenoidal]] [[microsurgery]]. | |||
*Surgery is normally offered if there is a rapid growth of lesion. | |||
*Surgical response is typically better when the [[seizure]] focus has been found by [[EEG]] to originate in or near the mass. | |||
*The specific location of the lesion relative to the [[pituitary]] and [[pituitary stalk|infundibulum]] and the amount of hormonal disturbance at presentation can help predict risk of [[hypopituitarism]] following surgery.<ref>{{cite journal |author=Pascual-Castroviejo I, Moneo JH, Viaño J, García-Segura JM, Herguido MJ, Pascual Pascual SI |title=[Hypothalamic hamartomas: control of seizures after partial removal in one case] |language=Spanish|journal=Rev Neurol |volume=31 |issue=2 |pages=119–22 |year=2000 |pmid=10951665 }}</ref> | |||
===Cardiac Hamartoma=== | |||
=== | *Complete surgical excision is the main choice [[surgery]] for symptomatic patients with [[cardiac]] hamartoma. | ||
*Other intervention may be partial excision. However, this procedure is only indicated when the [[tumor]] size is more extensive. | |||
*[[Postsurgical]] recurrence is rare.<ref name="pmid20850353">{{cite journal |vauthors=Bradshaw SH, Hendry P, Boodhwani M, Dennie C, Veinot JP |title=Left ventricular mesenchymal hamartoma, a new hamartoma of the heart |journal=Cardiovasc. Pathol. |volume=20 |issue=5 |pages=307–14 |year=2011 |pmid=20850353 |doi=10.1016/j.carpath.2010.07.007 |url=}}</ref> | |||
===Kidneys, Spleen, and Other Vascular Organs Hamartomas=== | |||
*Laparoscopic [[splenectomy]] is the standard procedure for most of benign and [[malignant]] [[splenic]] tumors.<ref name="pmid18293036">{{cite journal |vauthors=Habermalz B, Sauerland S, Decker G, Delaitre B, Gigot JF, Leandros E, Lechner K, Rhodes M, Silecchia G, Szold A, Targarona E, Torelli P, Neugebauer E |title=Laparoscopic splenectomy: the clinical practice guidelines of the European Association for Endoscopic Surgery (EAES) |journal=Surg Endosc |volume=22 |issue=4 |pages=821–48 |year=2008 |pmid=18293036 |doi=10.1007/s00464-007-9735-5 |url=}}</ref> | |||
*Other tumors, such as [[Angiomyolipoma|angiomyolipomas]] do not normally require [[surgery]] unless there is life-threatening [[bleeding]]. | |||
Laparoscopic splenectomy is the standard procedure for most of benign and malignant splenic tumors.<ref name="pmid18293036">{{cite journal |vauthors=Habermalz B, Sauerland S, Decker G, Delaitre B, Gigot JF, Leandros E, Lechner K, Rhodes M, Silecchia G, Szold A, Targarona E, Torelli P, Neugebauer E |title=Laparoscopic splenectomy: the clinical practice guidelines of the European Association for Endoscopic Surgery (EAES) |journal=Surg Endosc |volume=22 |issue=4 |pages=821–48 |year=2008 |pmid=18293036 |doi=10.1007/s00464-007-9735-5 |url=}}</ref> Other tumors, such as angiomyolipomas do not normally require surgery unless there is life-threatening bleeding. Some centers may perform preventative selective [[embolisation]] of the angiomyolipoma if it is more than | *Some centers may perform preventative selective [[embolisation]] of the [[angiomyolipoma]] if it is more than 4cm in diameter, due to the risk of [[hemorrhage]].<ref name="Loffroy2010">{{cite journal|last=Loffroy|first=R|author2=Rao, P|author3=Kwak, BK|author4=Ota, S|author5=De Lin, M|author6=Liapi, E|author7= Geschwind, JF|title=Transcatheter arterial [[embolization]] in patients with kidney diseases: an overview of the technical aspects and clinical indications.|journal=Korean journal of radiology : official journal of the Korean Radiological Society|date=May–Jun 2010|volume=11|issue=3|pages=257–68|pmid=20461179|url=http://www.kjronline.org/Synapse/Data/PDFData/0068KJR/kjr-11-257.pdf|doi=10.3348/kjr.2010.11.3.257|pmc=2864852}}</ref> | ||
==References== | ==References== | ||
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American Roentgen Ray Society Images of Hamartoma surgery |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Shyam Patel [2] Associate Editor(s)-in-Chief: Maria Fernanda Villarreal, M.D. [3]
Overview
Surgery is the mainstay of therapy for hamartomas. There are different anatomic approaches for different anatomic sites.
Surgery
Pulmonary Hamartoma
- Wedge resection is the mainstay of therapy for patients with pulmonary hamartoma.[1]
- Other interventions, such as aggressive lobectomy or total pneumonectomy are only considered when the central intrapulmonary hamartoma is located in the deep part of pulmonary lobes or adhered severely to hilum, and/or the distal lung tissue is nonfunctional.
- Intraoperative frozen section is necessary to rule out malignancy.
Hypothalamic Hamartoma
- Hypothalamic hamartomas can be effectively treated with a variety of surgical approaches.
- The most effective approach is the magnetic resonance imaging (MRI)-guided stereotactic laser ablation (SLA).
- This approach offers a a potentially safer, minimally invasive method with high efficacy for the hypothalamic hamartoma treatment.[2]
- Other specific surgical options include; stereotactic thermocoagulation, gamma knife radiosurgery, and physical resection by transsphenoidal microsurgery.
- Surgery is normally offered if there is a rapid growth of lesion.
- Surgical response is typically better when the seizure focus has been found by EEG to originate in or near the mass.
- The specific location of the lesion relative to the pituitary and infundibulum and the amount of hormonal disturbance at presentation can help predict risk of hypopituitarism following surgery.[3]
Cardiac Hamartoma
- Complete surgical excision is the main choice surgery for symptomatic patients with cardiac hamartoma.
- Other intervention may be partial excision. However, this procedure is only indicated when the tumor size is more extensive.
- Postsurgical recurrence is rare.[4]
Kidneys, Spleen, and Other Vascular Organs Hamartomas
- Laparoscopic splenectomy is the standard procedure for most of benign and malignant splenic tumors.[5]
- Other tumors, such as angiomyolipomas do not normally require surgery unless there is life-threatening bleeding.
- Some centers may perform preventative selective embolisation of the angiomyolipoma if it is more than 4cm in diameter, due to the risk of hemorrhage.[6]
References
- ↑ Guo W, Zhao YP, Jiang YG, Wang RW, Ma Z (2008). "Surgical treatment and outcome of pulmonary hamartoma: a retrospective study of 20-year experience". J. Exp. Clin. Cancer Res. 27: 8. doi:10.1186/1756-9966-27-8. PMC 2438336. PMID 18577258.
- ↑ Wilfong AA, Curry DJ (2013). "Hypothalamic hamartomas: optimal approach to clinical evaluation and diagnosis". Epilepsia. 54 Suppl 9: 109–14. doi:10.1111/epi.12454. PMID 24328883.
- ↑ Pascual-Castroviejo I, Moneo JH, Viaño J, García-Segura JM, Herguido MJ, Pascual Pascual SI (2000). "[Hypothalamic hamartomas: control of seizures after partial removal in one case]". Rev Neurol (in Spanish). 31 (2): 119–22. PMID 10951665.
- ↑ Bradshaw SH, Hendry P, Boodhwani M, Dennie C, Veinot JP (2011). "Left ventricular mesenchymal hamartoma, a new hamartoma of the heart". Cardiovasc. Pathol. 20 (5): 307–14. doi:10.1016/j.carpath.2010.07.007. PMID 20850353.
- ↑ Habermalz B, Sauerland S, Decker G, Delaitre B, Gigot JF, Leandros E, Lechner K, Rhodes M, Silecchia G, Szold A, Targarona E, Torelli P, Neugebauer E (2008). "Laparoscopic splenectomy: the clinical practice guidelines of the European Association for Endoscopic Surgery (EAES)". Surg Endosc. 22 (4): 821–48. doi:10.1007/s00464-007-9735-5. PMID 18293036.
- ↑ Loffroy, R; Rao, P; Kwak, BK; Ota, S; De Lin, M; Liapi, E; Geschwind, JF (May–Jun 2010). "Transcatheter arterial [[embolization]] in patients with kidney diseases: an overview of the technical aspects and clinical indications" (PDF). Korean journal of radiology : official journal of the Korean Radiological Society. 11 (3): 257–68. doi:10.3348/kjr.2010.11.3.257. PMC 2864852. PMID 20461179. URL–wikilink conflict (help)