Gamma knife surgery in mesial temporal lobe epilepsy: a prospective multicenter study.
OBJECTIVE
This article is the first prospective documentation of the efficacy and safety of gamma knife surgery (GKS) in the treatment of drug-resistant epilepsies of mesial temporal lobe origin.


METHODS
From July 1996 to March 2000, three European centers selected 21 patients with mesial temporal lobe epilepsy (MTLE) for a temporal lobectomy. The preoperative investigations included video-EEG with foramen ovale electrodes, magnetic resonance imaging, neuropsychological testing, and the ESI-55 quality-of-life questionnaire. In place of a cortectomy, radiosurgical treatment was performed by using the Leksell Gamma Knife (LGK) at a dose of 24 +/- 1 Gy at the margin. The target included the anterior parahippocampal cortex and the basal and lateral part of the amygdala and anterior hippocampus (head and body). One patient (a heavy smoker) died of a myocardial infarction. Twenty patients were available for prospective evaluation. A minimum 2-year follow-up period included clinical, neuropsychological, and radiologic evaluations.


RESULTS
At each 6-month follow-up evaluation, the frequency of seizures was significantly smaller than that at the previous visit. The median seizure frequency of 6.16 the month before treatment was reduced to 0.33 at 2 years after treatment. At 2 years, 65% of the patients (13 of 20) were seizure free. Five patients had transient side effects, including depression, headache, nausea, vomiting, and imbalance. There was no permanent neurological deficit reported except nine visual field deficits. No neuropsychological deterioration was observed 2 years after treatment. The quality of life was significantly better than that before surgery.


CONCLUSIONS
The safety and efficacy of the radiosurgical treatment of MTLEs appears good in this group of patient over short-to-middle term. Delay of the seizure cessation was the major disadvantage of GKS. A longer follow-up period is required for confirmation of these results.
Régis
Jean
J
Stereotactic and Functional Neurosurgery Department, Timone Hospital, Marseille (APM), France. j.regis@ap-hm.fr
Rey
Marc
M
Bartolomei
Fabrice
F
Vladyka
Vilibald
V
Liscak
Roman
R
Schröttner
Oskar
O
Pendl
Gerhard
G
D000328:Adult; D038481:Anterior Temporal Lobectomy / Q000379:methods; D004569:Electroencephalography / Q000706:statistics & numerical data; D004833:Epilepsy, Temporal Lobe / Q000175:diagnosis / Q000523:psychology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006304:Health Status; D006624:Hippocampus / Q000473:pathology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D011446:Prospective Studies; D011788:Quality of Life; D016634:Radiosurgery / Q000379:methods*; D012597:Sclerosing Solutions; D013702:Temporal Lobe / Q000601:surgery*; D016896:Treatment Outcome
D012597:Sclerosing Solutions