Perioperative Costs between Stereotactic Laser Ablation and Craniotomy for Hypothalamic Hamartoma

Perioperative Costs between Stereotactic Laser Ablation and Craniotomy for Hypothalamic Hamartoma

We read the article on “Perioperative Costs between Stereotactic Laser Ablation and Craniotomy for Hypothalamic Hamartoma” with a great interest.[1] Lam et al found that “children undergoing SLA for HH have a shorter length of stay and lower cost of hospitalization compared with those who underwent craniotomy and resection for the same diagnosis” and concluded that “SLA may represent an attractive alternative to craniotomy for the treatment of refractory epilepsy secondary to HH.”[1] For the cost, there are many issues to be addressed. The indirect cost (such as expenses and opportunity loss of family) must be assessed. The instrumentation cost must also be assessed in comparative study. Also, the cost for training of the new surgical technique should not be forgotten. In addition, an important determinant for the cost is the quality of care. In any setting with poor patient care, there will be a high rate of perioperative complication and this is an additional cost. Du et al noted that “although morbidity appears to be lower than other open approaches, complications related to LITT and their avoidance should be considered carefully.”[2] In the present study, an important question is whether there is a selection bias for allocation of the case for each surgical approach.

• References

• 1 Lam S, Hadley C, Curry DJ, Pan IW. Comparison of perioperative costs between stereotactic laser ablation and craniotomy for hypothalamic hamartoma. J Pediatr Epilepsy 2017; 6 (02) 97-102
• 2 Du VX, Gandhi SV, Rekate HL, Mehta AD. Laser interstitial thermal therapy: a first line treatment for seizures due to hypothalamic hamartoma?. Epilepsia 2017; 58 (Suppl. 02) 77-84