An Update of Gamma Knife Surgery Safety-Efficacy in Mesial Temporal Lobe Epilepsy.
Abstract number :
2.337
Submission category :
Year :
2001
Submission ID :
606
Source :
www.aesnet.org
Presentation date :
12/1/2001 12:00:00 AM
Published date :
Dec 1, 2001, 06:00 AM
Authors :
J.M. Regis, MD, Neurosurgery, Timone University Hospital, Marseille, France; F. Bartolomei, Phd, Neurophysiology, Timone University Hospital, Marseille, France; M. Rey, Phd, Neurophysiology, Timone Universi, Marseille, France; M. Hayashi, MD, Neurosurgery
RATIONALE: Gamma Knife Surgery (GKS) allows to reduce invasivity. Its advantages, well demonstrated in other indications, include confort, low morbidity, no mortality, short hospital stay and low cost and fit well with the goals of Epilepsy Surgery pecularly in term of safety and confort. Since 1993 we have systematically evaluated Gamma Knife radiosurgery in the field of Epilepsy Surgery. First series has been published in 1999 (1). The results of GK in this indication are updated after a longer follow-up.
METHODS: Between march 1993 and May 2001 in the frame of our Epilepsy Surgery comprehensive program we have operated by GKS 49 Mesial Temporal Lobe Epilepsies (MTLEA follow up superior to 24 months (25- 98) is available for 18 patients. The preoperative evaluation program was the one we usually perform for patients selected for microsurgery of MTLE. In lieu of microsurgery, the treatment of amygdalohippocampic structures was performed by using GK radiosurgery. The marginal dose was between 20 and 24 Gy.
RESULTS: Fithteen of these 18 patients (83%) were in Engel class I, 1 is a failure, 2 only improved. The median latency in seizure cessation was 10,5 months (range 6-21) apart from two patients who were immediatly seizure free. The median latency in aura cessation was 15,5 months (range 16-15,5). Morphologic (MRI) signs took place at 11 months (median) after GK surgery (7-22). During the period of onset of these radiological changes three patients experienced headache associated in two cases with nausea and vomiting. In these three patients these signs resolved after prescription of low doses of steroids. Some patients experienced complex or simple partial seizures during AEDs withdrawal but are still satisfactory controled by the reintroduction of previous AED treatment. No permanent neurological side effect (except three cases of non symptomatic visual field deficit) or morbidity and no mortality was observed.
CONCLUSIONS: This initial experience proves clearly the middle-term efficiency and safety of GK for MTLE surgery. These results need further confirmation of long-term efficiency.
- 1. Régis J., Bartolomei F., Rey M., Genton P., Dravet C., Semah F., Gastaut J., Chauvel P., Peragut J. - Gamma knife surgery for mesial temporal lobe epilepsy. Epilepsia, 1999, 40, 1551-1556.