Safe electrophysiology-guided resection of an epileptogenic non-exophytic hamartoma at the floor of the fourth ventricle in a child.

Hamartoma of the floor of fourth ventricle (HFFV) is an extremely rare entity known to be causing focal movement disorders in children. According to the few reported cases in literature, the only effective treatment is disconnection or resection of the lesion which can be very challenging in this anatomic area. We report a 15-year-old child with a fourth ventricle floor's limited nonexophytic hamartoma revealed by brief paroxysmal movement disorder episodes since the age of 5 months, without EEG correlate. He was treated for the first time by safe surgical electrophysiology-guided resection, with promising results on epileptic disease. This positive result opens interesting prospects for improving the surgical management of other lesions affecting this anatomical region, while limiting postoperative neurological deficits.