A hypersomnolent girl with decreased CSF hypocretin level after removal of a hypothalamic tumor

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Abstract
Discovery of a tumor in a 16-year-old girl with headache prompted a neurosurgical translamina terminalis resection to remove a suprasellar Grade 2 pilocystic astrocytoma. The surgical report described the tumor as an intra-axial, poorly circumscribed lesion arising in the left hypothalamus, occupying both sides of the hypothalamus; the thalamus and other surrounding brain structures were spared. The tumor and its gliotic rim were removed throughout the prechiasmatic cistern, except for the portion adhering to the third ventricle in the upper right hypothalamus. Tumor removal resulted in hypothalamic injury to both sides of the ventromedial, dorsomedial nuclei, and perifornical regions as well as right nucleus of the posterior hypothalamus …