Failure of Gamma Knife Radiosurgery for Mesial Temporal Lobe Epilepsy: Report of Five Cases

Srikijvilaikul, Teeradej; Najm, Imad; Foldvary‐Schaefer, Nancy; Lineweaver, Tara T.; Suh, John H.; Bingaman, William

doi:10.1227/01.neu.0000124604.29767.eb

Cited by 81 publications

(84 citation statements)

References 17 publications

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“…On the other hand, in humans, seizure remission after RS of other epileptic lesions-hypothalamic hamartomas or vascular malformations-does not require radiologic changes consistent with radionecrosis. 33,34 Similarly, histopathology of hippocampal specimens obtained from open temporal lobectomy after failed RS for MTLE 1,3,7 demonstrates perivascular sclerosis and hyalinization, rather than necrosis. However, since these specimens were obtained from unsuccessful RS, they may not be sufficient to explain the changes required for successful RS in MTLE.…”

Section: Fluid-attenuated Inversion Recovery Coronal (A-e) T1 Coronamentioning

confidence: 99%

Predictors of efficacy after stereotactic radiosurgery for medial temporal lobe epilepsy

Chang

Quigg

et al. 2010

Neurology

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Section: Fluid-attenuated Inversion Recovery Coronal (A-e) T1 Coronamentioning

confidence: 99%

Predictors of efficacy after stereotactic radiosurgery for medial temporal lobe epilepsy

Chang

Quigg

et al. 2010

Neurology

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“…The effect of gamma knife treatment reported in the literature rarely appears immediately after treatment, but usually 8 to 15 months later (Srikijvilaikul et al, 2004). According to the latest foreign statistical data on long-term follow-up cases, although the effect of anteromedial temporal resection drifts over time, the overall trend is stable and durable (Hoshida, 2011).…”

Section: Discussionmentioning

confidence: 99%

Curative effect and costs of surgical and gamma knife treatments on intractable epilepsy caused by temporal-hippocampal sclerosis

Zt¹,

Chen²

2015

Genet. Mol. Res.

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ABSTRACT. This study aimed to investigate the curative effect and costs of surgical and gamma knife treatments on intractable epilepsy caused by temporal-hippocampal sclerosis. The subjects comprised patients who suffered from intractable epilepsy caused by temporalhippocampal sclerosis and received treatment in the Department of Neurosurgery of our hospital between 2010 and 2011. After obtaining their consent, patients were evaluated and selected to receive surgical or gamma knife treatments. In the surgical group, the short-term curative rate was 92.60% and the average cost was US$ 1311.50 while in the gamma knife group, the short-term curative rate was 53.79%, and the average cost was US$ 2786.90. Both surgical and gamma knife treatments of intractable epilepsy caused by temporal-hippocampal sclerosis are safe and effective, Z.T. Han and Q.X. Chen 8556©FUNPEC-RP www.funpecrp.com.br Genetics and Molecular Research 14 (3): 8555-8562 (2015) but the short-term curative effect of surgical treatment is better than that of gamma knife, and its cost is lower.

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“…In other studies, resective surgery was also performed following GKRS because of insufficient treatment effect, and most patients became seizure-free immediately after open surgery. 3,13,25,30,36) Furthermore, delayed seizure control of GKRS exposes patients to many risks such as injury, drowning, or unexpected death associated with seizure. 22) Immediate cessation of seizure seems to decrease mortality after epilepsy surgery.…”

Section: Discussionmentioning

confidence: 99%

“…In contrast, no beneficial effects of epilepsy surgery on survival were found compared with a control group of medically treated patients with intractable epilepsy. 31) Although sudden unexpected death in epilepsy (SUDEP) has been reported in previous studies of GKRS for MTLE, 3,30) the effect of epilepsy surgery on the risk of SUDEP remains unclear. 10,19,35) One of the serious complications associated with GKRS is DRN.…”

Section: Discussionmentioning

confidence: 99%

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Serious Adverse Effects of Gamma Knife Radiosurgery for Mesial Temporal Lobe Epilepsy

Kawamura

Onishi

Kohda

et al. 2012

Neurol. Med. Chir.(Tokyo)

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Gamma knife radiosurgery (GKRS) for mesial temporal lobe epilepsy (MTLE) has been proposed as an alternative to surgical resection. We report serious adverse effects of the treatment after follow-up periods over 9 years in 11 patients treated with GKRS between 1997 and 2000. The target volume of the entorhinoamygdalohippocampectomy area was 4.8-17.1 ml. Marginal dose of 20-25 Gy to the 50% isodose was delivered. One patient was drowned after suffering seizure 7 months after GKRS. Two patients did not show any reduction in seizure frequency over 9 and 18 months. Both patients requested open surgery and became seizure-free postoperatively. Four of the other eight patients were classified as Engel's class I within 4 years after GKRS. One of the four patients experienced symptomatic radiation-induced cerebral edema transiently, one developed radiation necrosis and required surgery 5 years after GKRS, and one developed cognitive impairment with hemiparesis 10 years after GKRS. Magnetic resonance (MR) imaging showed a large cyst in the irradiated temporal lobe. This patient recovered fully after the cyst excision. Only one patient became seizure-free and antiepileptic drug-free without symptomatic radiation-induced complications. However, MR imaging revealed abnormal enhancement, cyst formation, and diffuse white matter change in the irradiated temporal lobe 9 years after GKRS. GKRS for MTLE causes adverse effects of delayed seizure remission and symptomatic radiationinduced complications. Therefore, GKRS cannot be considered as an ideal alternative to surgery for MTLE. Long-term follow-up studies including MR imaging with contrast medium are required for the patients even after successful control of seizures.

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Failure of Gamma Knife Radiosurgery for Mesial Temporal Lobe Epilepsy: Report of Five Cases

Abstract: GKRS at the 20-Gy dose level did not lead to seizure control in patients with mesial temporal lobe epilepsy due to hippocampal sclerosis.

Cited by 81 publications

References 17 publications

Predictors of efficacy after stereotactic radiosurgery for medial temporal lobe epilepsy

Predictors of efficacy after stereotactic radiosurgery for medial temporal lobe epilepsy

Curative effect and costs of surgical and gamma knife treatments on intractable epilepsy caused by temporal-hippocampal sclerosis

Serious Adverse Effects of Gamma Knife Radiosurgery for Mesial Temporal Lobe Epilepsy

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