Gamma Knife radiosurgery relative to microsurgery: epilepsy.
There is a strong rationale for investigation of the role of Gamma Knife radiosurgery in the treatment of medically intractable epilepsy. To explore this potential application, the well established and highly successful current outcomes associated with microsurgical treatment were reviewed, and include for temporal resections seizure-free results in 65-70% of patients, with permanent morbidity of less than 5% and mortality less than 1%. Advantages of open surgery include the opportunity to conduct electrocorticography and functional mapping, excellent visualization enabling an assured and discrete line of resection, freedom in general from volume constraints, and immediate efficacy. The preliminary evidence in support of radiosurgical treatment includes several series of patients with epilepsy associated with arteriovenous malformation, tumor, or cavernous anginoma in which results approaching those of surgery have been achieved. In a series of 15 patients with mesial temporal sclerosis, all but one patient with follow-up of at least one year are seizure-free; morbidity has been limited to one asymptomatic field defect. A series of ten patients with epilepsy associated with hypothalamic hamartoma has achieved seizure improvement in six of eight patients with at least one year follow-up, and no major morbidity has been seen. Radiosurgical treatment for intractable epilepsy appears to be effective in a majority of patients and can be performed safely and efficiently. Early experimental evidence suggests that seizure control might in some instances be achievable without ablation of the pathological target.
Régis
Y
Y
Department of Neurosurgery, Centre Hospitalier Universitaire La Timone, Marseille, France.
Roberts
D W
DW
D004827:Epilepsy / Q000601:surgery*; D004833:Epilepsy, Temporal Lobe / Q000601:surgery; D006801:Humans; D008866:Microsurgery; D019635:Neurosurgical Procedures; D016634:Radiosurgery