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Samalens L, Courivaud C, Adam JF, Barbier EL, Serduc R, Depaulis A. Innovative minimally invasive options to treat drug-resistant epilepsies. Rev Neurol (Paris) 2023:S0035-3787(23)01038-X. [PMID: 37798162 DOI: 10.1016/j.neurol.2023.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 03/20/2023] [Accepted: 05/14/2023] [Indexed: 10/07/2023]
Abstract
Despite the regular discovery of new molecules, one-third of epileptic patients are resistant to antiepileptic drugs. Only a few can benefit from resective surgery, the current gold standard. Although effective in 50-70% of cases, this therapy remains risky, costly, and can be associated with long-term cognitive or neurological side effects. In addition, patients are increasingly reluctant to have a craniotomy, emphasizing the need for new less invasive therapies for focal drug-resistant epilepsies. Here, we review different minimally invasive approaches already in use in the clinic or under preclinical development to treat drug-resistant epilepsies. Localized thermolesion of the epileptogenic zone has been developed in the clinic using high-frequency thermo-coagulations or magnetic resonance imaging-guided laser or ultrasounds. Although less invasive, they have not yet significantly improved the outcomes when compared with resective surgery. Radiosurgery techniques have been used in the clinic for the last 20years and have proven efficiency. However, their efficacy is not better than resective surgery, and various side effects have been reported as well as the potential risk of sudden unexpected death associated with epilepsy. Recently, a new strategy of radiosurgery has emerged using synchrotron-generated X-ray microbeams: microbeam radiation therapy (MRT). The low divergence and high-flux of the synchrotron beams and the unique tolerance to MRT by healthy brain tissues, allows a precise targeting of specific brain regions with minimal invasiveness and limited behavioral or functional consequences in animals. Antiepileptic effects over several months have been recorded in animal models, and histological and synaptic tracing analysis suggest a reduction of neuronal connectivity as a mechanism of action. The possibility of transferring this approach to epileptic patients is discussed in this review.
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Affiliation(s)
- L Samalens
- Université Grenoble-Alpes, Inserm, U1216, Grenoble Institut Neurosciences, 38000 Grenoble, France; Université Grenoble-Alpes, Inserm, UA7, STROBE, 38000 Grenoble, France
| | - C Courivaud
- Université Grenoble-Alpes, Inserm, U1216, Grenoble Institut Neurosciences, 38000 Grenoble, France
| | - J-F Adam
- Université Grenoble-Alpes, Inserm, UA7, STROBE, 38000 Grenoble, France; Centre Hospitalier Universitaire Grenoble-Alpes, 38700 La Tronche, France
| | - E L Barbier
- Université Grenoble-Alpes, Inserm, U1216, Grenoble Institut Neurosciences, 38000 Grenoble, France
| | - R Serduc
- Université Grenoble-Alpes, Inserm, UA7, STROBE, 38000 Grenoble, France
| | - A Depaulis
- Université Grenoble-Alpes, Inserm, U1216, Grenoble Institut Neurosciences, 38000 Grenoble, France.
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Ganz JC. Epilepsy. PROGRESS IN BRAIN RESEARCH 2022; 268:329-345. [PMID: 35074089 DOI: 10.1016/bs.pbr.2021.10.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
GKNS has been introduced as an alternative to microsurgery for the treatment of certain types of focal epilepsy. It was first noted that epilepsy associated with AVMs often improved before the obliteration of the vascular lesion. It was subsequently shown that the treatment could be effective in mesial temporal lobe epilepsy (MTLE) producing remission in around 60% of patients, provided the treatment was carried out as originally designed. GKNS has also been useful in the treatment of gelastic epilepsy associated with hypothalamic hamartomas.
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Affiliation(s)
- Jeremy C Ganz
- Department of Neurosurgery, Haukeland University Hospital, Bergen, Norway.
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3
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Wang R, Beg U, Padmanaban V, Abel TJ, Lipsman N, Ibrahim GM, Mansouri A. A Systematic Review of Minimally Invasive Procedures for Mesial Temporal Lobe Epilepsy: Too Minimal, Too Fast? Neurosurgery 2021; 89:164-176. [PMID: 33862622 DOI: 10.1093/neuros/nyab125] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 02/13/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Cortico-amygdalohippocampectomy (CAH) is effective for mesial temporal lobe epilepsy (mTLE). Concerns regarding surgical morbidity have generated enthusiasm for more minimally invasive interventions. A careful analysis of current data is warranted before widespread adoption of these techniques. OBJECTIVE To systematically review the use of laser interstitial thermal therapy (LITT), stereotactic radiosurgery (SRS), radiofrequency thermocoagulation (RF-TC), and focused ultrasound for mTLE. METHODS Major online databases were searched for prospective observational studies, randomized clinical trials, and retrospective studies (>50 patients), including mTLE patients. Outcomes of interest were seizure freedom (Engel I), complications and re-operation rates, and neuropsychological and quality-of-life (QoL) data. RESULTS Nineteen publications were identified. At ≥6 mo postoperatively, LITT (9/19) Engel I outcomes ranged from 52% to 80%. SRS (3/19) has a latency period (52%-67%, 24-36 mo postoperatively) and the radiosurgery vs. open surgery for epilepsy (ROSE) trial reported inferiority of SRS compared to CAH. RF-TC (7/19) demonstrated variable seizure freedom rates (0%-79%) and high re-operation rates (0%-90%). Twelve studies reported neuropsychological outcomes but QoL (4/19) was not widely reported, and few studies (3/19) assessed both. Study quality ranged from fair to good. CONCLUSION Based on nonrandomized data, LITT has compelling evidence of efficacy; however, comparisons to surgical resection are lacking. SRS has a latency period and is inferior to CAH (ROSE trial). RF-TC is a less resource-intensive alternative to LITT; however, comparisons of efficacy are limited. Additional studies are needed before minimally invasive procedures can supplant standard surgery.
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Affiliation(s)
- Ryan Wang
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Usman Beg
- Midwestern University Arizona College of Osteopathic Medicine, Glendale, Arizona, USA
| | - Varun Padmanaban
- Department of Neurosurgery, Penn State Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Taylor J Abel
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Department of Bioengineering, University of Pittsburgh, Pennsylvania, USA
| | - Nir Lipsman
- Division of Neurosurgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Harquail Centre for Neuromodulation, Sunnybrook Research Institute, Hurvitz Brain Sciences Program, Toronto, Ontario, Canada
| | - George M Ibrahim
- Division of Neurosurgery, The Hospital for Sick Children, Toronto, Ontario, Canada.,Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
| | - Alireza Mansouri
- Department of Neurosurgery, Penn State Hershey Medical Center, Hershey, Pennsylvania, USA.,Penn State Cancer Institute, Hershey, Pennsylvania, USA
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Abe K, Yamaguchi T, Hori H, Sumi M, Horisawa S, Taira T, Hori T. Magnetic resonance-guided focused ultrasound for mesial temporal lobe epilepsy: a case report. BMC Neurol 2020; 20:160. [PMID: 32349706 PMCID: PMC7189704 DOI: 10.1186/s12883-020-01744-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 04/22/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND We report the first case of transcranial magnetic resonance-guided focused ultrasound (MRgFUS) for mesial temporal lobe epilepsy (MTLE). CASE PRESENTATION The target was located 20 mm lateral from the midline and 15 mm above the skull base (left hippocampus). Despite the application of maximal energy, the ablation temperature did not exceed 50 °C, probably because of the low number of effective transducer elements with incident angles below 25 degrees. The skull density ratio was 0.56. Post-operative magnetic resonance imaging did not reveal any lesion and the patient remained almost seizure-free for up to 12 months. CONCLUSIONS This preliminary case report suggests that MRgFUS may be effective for treating cases of MTLE. Therefore, the safety and feasibility of MRgFUS should be evaluated in future studies with larger numbers of participants and longer follow-up duration.
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Affiliation(s)
- Keiichi Abe
- Department of Neurosurgery, Tokyo Women's Medical University, Shinjuku-ku, Kawata-cho, 8-1, Tokyo, 162-0054, Japan.
| | - Toshio Yamaguchi
- Department of Radiology, Shinyurigaoka General Hospital, Kawasaki, Japan
| | - Hiroki Hori
- Faculty of Advanced Techno-Surgery, Institute of Advanced Biomedical Engineering & Science, Graduate School of Medicine, Tokyo Women's Medical University, Tokyo, Japan
| | - Masatake Sumi
- Department of Neurosurgery, Tokyo Women's Medical University, Shinjuku-ku, Kawata-cho, 8-1, Tokyo, 162-0054, Japan
| | - Shiro Horisawa
- Department of Neurosurgery, Tokyo Women's Medical University, Shinjuku-ku, Kawata-cho, 8-1, Tokyo, 162-0054, Japan
| | - Takaomi Taira
- Department of Neurosurgery, Tokyo Women's Medical University, Shinjuku-ku, Kawata-cho, 8-1, Tokyo, 162-0054, Japan
| | - Tomokatsu Hori
- Department of Neurosurgery, Moriyama Neurological Center Hospital, Tokyo, Japan
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Magnetic Resonance–Guided Laser Interstitial Thermal Therapy Versus Stereotactic Radiosurgery for Medically Intractable Temporal Lobe Epilepsy: A Systematic Review and Meta-Analysis of Seizure Outcomes and Complications. World Neurosurg 2019; 122:e32-e47. [DOI: 10.1016/j.wneu.2018.08.227] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 08/29/2018] [Accepted: 08/31/2018] [Indexed: 11/23/2022]
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Abstract
PURPOSE OF REVIEW This review provides an update and summary of recent neuropsychological findings in epilepsy focusing on three major clinical topics among the many developments in the field. We will critically outline the current state with regard to cognition in new-onset epilepsies, social cognition in epilepsy, and the long-term outcome of epilepsy surgery and the cognitive outcomes of superselective surgical procedures. RECENT FINDINGS Current studies indicate that neuropsychological impairments are prevalent already at the onset of epilepsy and even before, social cognition (i.e., emotion recognition and theory of mind) is impaired in different epilepsy populations, the long-term outcome of epilepsy surgery is mostly characterized by a stable or even improved cognitive status, and superselective epilepsy surgeries are associated with a promising neuropsychological outcome. SUMMARY The high prevalence of cognitive deficits around epilepsy onset challenges the assumption that epilepsy is the major cause of cognitive problems and calls for early neuropsychological diagnostics. Social cognition seems to be a relevant domain that is not yet routinely considered in epilepsy. The cognitive long-term outcome of epilepsy surgery is mostly positive. Stereotactic thermocoagulation and gamma knife surgery appear to be cognitively safe procedures.
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Eekers DB, Pijnappel EN, Schijns OE, Colon A, Hoeben A, Zindler JD, Postma AA, Hoffmann AL, Lambin P, Troost EG. Evidence on the efficacy of primary radiosurgery or stereotactic radiotherapy for drug-resistant non-neoplastic focal epilepsy in adults: A systematic review. Seizure 2018; 55:83-92. [DOI: 10.1016/j.seizure.2018.01.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 01/09/2018] [Accepted: 01/11/2018] [Indexed: 12/28/2022] Open
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Radiosurgery for epilepsy: Systematic review and International Stereotactic Radiosurgery Society (ISRS) practice guideline. Epilepsy Res 2017; 137:123-131. [DOI: 10.1016/j.eplepsyres.2017.08.016] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2017] [Accepted: 08/27/2017] [Indexed: 10/18/2022]
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Witt JA, Hoppe C, Helmstaedter C. Neuropsychologist's (re-)view: Resective versus ablative amygdalohippocampectomies. Epilepsy Res 2017; 142:161-166. [PMID: 28890320 DOI: 10.1016/j.eplepsyres.2017.08.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 06/27/2017] [Accepted: 08/30/2017] [Indexed: 10/18/2022]
Abstract
Pharmacoresistant mesial temporal lobe epilepsy (mTLE) represents the major indication for epilepsy surgery. Since epilepsy surgery is an elective treatment option, preserving cognition is a high priority. Given the essential role of temporomesial structures in declarative long-term memory formation, surgical treatment for mTLE is primarily associated with a risk of material-specific memory decline, but other cognitive domains may be affected as well. The major determinants for the neuropsychological outcome are the functional integrity of surgically affected tissues, the functional reserve capacities of the remnant brain, the postoperative seizure outcome, as well as the quantitative and qualitative changes of antiepileptic drugs. Anterior temporal lobectomy has long been the standard procedure for treating mTLE. However, if an exclusive mesial pathology is present, then functional non-pathological tissues of the temporal pole and neocortex are sacrificed. As a result, more selective or tailored surgical approaches have been developed which strive towards minimizing iatrogenic effects. However, whether or not these approaches are equipotential with regard to seizure control is still a matter of debate. The quality of the presurgical diagnostics could also be decisive. Selective surgery should indeed be selective in terms of preventing evitable collateral cortical damage along the approach. Invasivity and risks of collateral damage associated with "open" selective resective surgery are further minimized by stereotactic ablative surgery via thermocoagulation, or eventually even eliminated by gamma knife surgery. From a neuropsychological point of view, this development is consequent and desirable, but no clear scientific evidence of a superior cognitive outcome after radiosurgery or thermocoagulation currently exists. The studies that are available contain significant methodological limitations. Thus, randomized head-to-head cognitive outcome studies of competing selective procedures are needed, which should meet the minimum requirements for study design and neuropsychological evaluations. Finally, none of the surgical treatment variants can systematically prevent memory decline when the hippocampus is targeted.
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Affiliation(s)
- Juri-Alexander Witt
- Department of Epileptology, University of Bonn Medical Center, Bonn, Germany.
| | - Christian Hoppe
- Department of Epileptology, University of Bonn Medical Center, Bonn, Germany
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Feng ES, Sui CB, Wang TX, Sun GL. Stereotactic radiosurgery for the treatment of mesial temporal lobe epilepsy. Acta Neurol Scand 2016; 134:442-451. [PMID: 26846702 DOI: 10.1111/ane.12562] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/29/2015] [Indexed: 12/01/2022]
Abstract
OBJECTIVES Stereotactic radiosurgery (RS) is a potential option for some patients with temporal lobe epilepsy (TLE). The aim of this meta-analysis was to determine the pooled seizure-free rate and the time interval to seizure cessation in patients with lesions in the mesial temporal lobe, and who were eligible for either stereotactic or gamma knife RS. MATERIALS & METHODS We searched the Medline, Cochrane, EMBASE, and Google Scholar databases using combinations of the following terms: RS, stereotactic radiosurgery, gamma knife, and TLE. RESULTS We screened 103 articles and selected 13 for inclusion in the meta-analysis. Significant study heterogeneity was detected; however, the included studies displayed an acceptable level of quality. We show that approximately half of the patients were seizure free over a follow-up period that ranged from 6 months to 9 years [pooled estimate: 50.9% (95% confidence interval: 0.381-0.636)], with an average of 14 months to seizure cessation [pooled estimate: 14.08 months (95% confidence interval: 11.95-12.22 months)]. Nine of 13 included studies reported data for adverse events (AEs), which included visual field deficits and headache (the two most common AEs), verbal memory impairment, psychosis, psychogenic non-epileptic seizures, and dysphasia. Patients in the individual studies experienced AEs at rates that ranged from 8%, for non-epileptic seizures, to 85%, for headache. CONCLUSION Our findings indicate that RS may have similar or slightly less efficacy in some patients compared with invasive surgery. Randomized controlled trials of both treatment regimens should be undertaken to generate an evidence base for patient decision-making.
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Affiliation(s)
- E.-S. Feng
- Department of Neurosurgery; Beijing Ditan Hospital; Capital Medical University; Beijing China
| | - C.-B. Sui
- Department of Neurology; Beihai Hospital; Yantai Shandong China
| | - T.-X. Wang
- Department of Neurosurgery; Yidu Central Hospital of Weifang; Weifang Shandong China
| | - G.-L. Sun
- Department of Neurosurgery; Yidu Central Hospital of Weifang; Weifang Shandong China
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Malikova H, Koubska E, Vojtech Z, Weichet J, Syrucek M, Sroubek J, Rulseh A, Liscak R. Late morphological changes after radiosurgery of brain arteriovenous malformations: an MRI study. Acta Neurochir (Wien) 2016; 158:1683-90. [PMID: 27368701 PMCID: PMC4980423 DOI: 10.1007/s00701-016-2876-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Accepted: 06/07/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Radiosurgery by Gamma Knife (GK) is an effective treatment for brain arteriovenous malformations (AVM). The aim of the present study was to evaluate late, radiation-induced changes detectable by MRI after AVM radiosurgery in patients treated minimally 10 years prior, with AVM obliteration proven by angiography. METHODS Thirty-five patients with 37 AVMs were included. AVMs were irradiated 16.6 ± 3.5 years prior with AVM obliteration proven 13 ± 4 years prior. All patients underwent recent MRI examinations, including application of gadolinium-based contrast. RESULTS In one case, post-irradiative cystic formation with mass effect and signs of hemorrhage requiring surgery was found. Post-gadolinium enhancement at the site of obliterated nidi was apparent in 28 of 37 cases (76 %). In all cases except one, the mean volume of enhancement at the time of review was clearly lower than the volume of the originally irradiated AVM (88 ± 20 %; median 92 %); in one case the extent was 142 % greater than the irradiated AVM. When we compared enhancing and non-enhancing nidi, we found that enhancing nidi were significantly larger than non-enhancing nidi at the time of radiosurgery (4.39 ± 3.35 cc vs. 0.89 ± 0.79 cc, p = 0.004). Enhancement was not influenced by total radiation dose, patient age at the time of irradiation, duration since radiosurgery, or the number of irradiations. Wallerian degeneration was found in nine of 37 cases (24 %); in six cases the optical tracts were affected and visual field defects were proven. In five of nine cases (55.6 %) with Wallerian degeneration previous hemorrhage was present. Dual vascular pathology was found in eight of 35 patients (23 %). CONCLUSIONS GK radiosurgery for AVM is a safe treatment method although delayed complications may occur. Post-gadolinium enhancement of obliterated nidi may indicate an active post-irradiative process.
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Affiliation(s)
- Hana Malikova
- Department of Radiology, Na Homolce Hospital, Roentgenova 2, 150 00, Prague, Czech Republic.
- Institute of Anatomy, Second Medical Faculty, Charles University in Prague, U Nemocnice 3, 120 00, Prague, Czech Republic.
| | - Eva Koubska
- Department of Radiology, Na Homolce Hospital, Roentgenova 2, 150 00, Prague, Czech Republic
| | - Zdenek Vojtech
- Department of Neurology, Na Homolce Hospital, Roentgenova 2, 15000, Prague, Czech Republic
- Department of Neurology, 3rd Medical Faculty, Charles University in Prague, Ruska 87, 10000, Prague, Czech Republic
| | - Jiri Weichet
- Department of Radiology, Na Homolce Hospital, Roentgenova 2, 150 00, Prague, Czech Republic
| | - Martin Syrucek
- Department of Pathology, Na Homolce Hospital, Roentgenova 2, 15000, Prague, Czech Republic
| | - Jan Sroubek
- Department of Neurosurgery, Na Homolce Hospital, Roentgenova 2, 15000, Prague, Czech Republic
| | - Aaron Rulseh
- Department of Radiology, Na Homolce Hospital, Roentgenova 2, 150 00, Prague, Czech Republic
| | - Roman Liscak
- Department of Stereotactic and Radiation Neurosurgery, Na Homolce Hospital, Roentgenova 2, 15000, Prague, Czech Republic
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Abstract
Pediatric epilepsy is a debilitating condition that impacts millions of patients throughout the world. Approximately 20-30% of children with recurrent seizures have drug-resistant epilepsy (DRE). For these patients, surgery offers the possibility of not just seizure freedom but significantly improved neurocognitive and behavioral outcomes. The spectrum of surgical options is vast, ranging from outpatient procedures such as vagus nerve stimulation to radical interventions including hemispherectomy. The thread connecting all of these interventions is a common goal-seizure freedom, an outcome that can be achieved safely and durably in a large proportion of patients. In this review, we discuss many of the most commonly performed surgical interventions and describe the indications, complications, and outcomes specific to each.
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Affiliation(s)
- Jian Guan
- 1 Division of Pediatric Neurosurgery, Department of Neurosurgery, Primary Children's Hospital, University of Utah, Salt Lake City, Utah, USA ; 2 Division of Neurosurgery, University of Vermont, Burlington, Vermont, USA
| | - Michael Karsy
- 1 Division of Pediatric Neurosurgery, Department of Neurosurgery, Primary Children's Hospital, University of Utah, Salt Lake City, Utah, USA ; 2 Division of Neurosurgery, University of Vermont, Burlington, Vermont, USA
| | - Katrina Ducis
- 1 Division of Pediatric Neurosurgery, Department of Neurosurgery, Primary Children's Hospital, University of Utah, Salt Lake City, Utah, USA ; 2 Division of Neurosurgery, University of Vermont, Burlington, Vermont, USA
| | - Robert J Bollo
- 1 Division of Pediatric Neurosurgery, Department of Neurosurgery, Primary Children's Hospital, University of Utah, Salt Lake City, Utah, USA ; 2 Division of Neurosurgery, University of Vermont, Burlington, Vermont, USA
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Radiosurgery for mesial temporal lobe epilepsy. Acta Neurochir (Wien) 2015; 157:1793-4. [PMID: 26266879 DOI: 10.1007/s00701-015-2527-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Accepted: 07/28/2015] [Indexed: 10/23/2022]
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Vojtěch Z, Malíková H, Syrůček M, Krámská L, Šroubek J, Vladyka V, Liščák R. Morphological changes after radiosurgery for mesial temporal lobe epilepsy. Acta Neurochir (Wien) 2015; 157:1783-91; discussion 1791-2. [PMID: 26277098 PMCID: PMC4569650 DOI: 10.1007/s00701-015-2525-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2015] [Accepted: 07/28/2015] [Indexed: 11/24/2022]
Abstract
Background To review our experience with morphological developments during the long-term follow-up of patients treated by Gamma Knife radiosurgery for mesial temporal lobe epilepsy. Method Between 1995 and 1999, we treated 14 patients with marginal doses of 24 Gy (n = 6) and 18–20 Gy (n = 8). Nine of these were operated on for insufficient seizure control. We reviewed seizure outcome and magnetic resonance images in both operated and unoperated patients and also re-examined histopathology specimens. Results Of the nine operated patients, two were Engel IIIA, one was IVA, five were IVB, and one was Engel IVC prior to surgery. At their final visit, five cases had become Engel class IA, one patient was ID, and two were IIC. In one patient the follow-up was not long enough for classification. Of the five unoperated patients, one was Engel class IB, one was IIIA, one IIB and one IVB at their final visit. Radionecrosis developed in 11 patients, occurring more often and earlier in those treated with higher doses. Collateral edema reached outside the temporal lobe in six patients, caused uncal herniation in two and intracranial hypertension in three. During longer follow-up, postnecrotic pseudocysts developed in 9 patients, and postcontrast enhancement persisted for 2.5–16 years after GKRS in all 14 patients. In five of them we detected its progression between 2 and 16 years after treatment. Signs of neoangiogenesis were found in two patients and microbleeds could be seen in five. Histopathology revealed blood vessel proliferation and macrophage infiltration. Conclusions Early delayed complications and morphological signs suggesting a risk of development of late delayed complications are frequent after radiosurgery for mesial temporal lobe epilepsy. Together with its unproven antiseizure efficacy, these issues should be taken into account when planning future studies of this method. Electronic supplementary material The online version of this article (doi:10.1007/s00701-015-2525-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Zdeněk Vojtěch
- Department of Neurology, Na Homolce Hospital, Roentgenova 2, 15030, Prague 5-Motol, Czech Republic.
| | - Hana Malíková
- Department of Radiodiagnostics, Na Homolce Hospital, Prague, Czech Republic
| | - Martin Syrůček
- Department of Pathology, Na Homolce Hospital, Prague, Czech Republic
| | - Lenka Krámská
- Department of Psychology, Na Homolce Hospital, Prague, Czech Republic
| | - Jan Šroubek
- Department of Neurosurgery, Na Homolce Hospital, Prague, Czech Republic
| | - Vilibald Vladyka
- Department of Stereotactic and Radiation Neurosurgery, Na Homolce Hospital, Prague, Czech Republic
| | - Roman Liščák
- Department of Stereotactic and Radiation Neurosurgery, Na Homolce Hospital, Prague, Czech Republic
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Ogbonnaya ES, Peev N, Nagaraja S, Dardis R. Double trouble: a tale of two radio-treatments. BMJ Case Rep 2014; 2014:bcr-2014-205922. [PMID: 25239997 DOI: 10.1136/bcr-2014-205922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
In recent years, an increasing number of patients are treated with radiation. In the early era of radiotherapy, which began soon after X-rays were discovered by Roentgen in 1895, tumours were irradiated with high doses of X-rays in a single fraction. The major initial setback was the damage caused to normal tissues; however, in recent times the use of stereotactic radiosurgery, which delivers high doses of radiation precisely to abnormal tissue targets while sparing the surrounding normal brain tissue, and particularly for surgically inaccessible tumours, has taken centre stage. Prophylactic whole brain radiation (in conjunction with aggressive chemotherapy) for childhood acute lymphoblastic leukaemia has been shown to improve patient survival, however, this is associated with complications in survivors. We report an interesting case of one of the longest survivors who has had double complications from radiotherapy-based interventions.
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Affiliation(s)
- Ebere Sunny Ogbonnaya
- Department of Neurosurgery, University Hospital Coventry and Warwickshire, Coventry, Coventry, UK
| | - Nikolay Peev
- Department of Neurosurgery, Salford Royal Hospital, Manchester, Manchester, UK
| | - Sanjoy Nagaraja
- Department of Radiology, University Hospital Coventry and Warwickshire, Coventry, Coventry, UK
| | - Ronan Dardis
- Department of Neurosurgery, University Hospital Coventry and Warwickshire, Coventry, Coventry, UK
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