Delayed complications after Gamma Knife surgery for intractable epilepsy.
Despite the controversy concerning the clinical usefulness of Gamma Knife surgery (GKS; Elekta AB, Stockholm, Sweden) for intractable epilepsy, this treatment modality has attracted attention due to its low invasiveness. We report the long-term outcomes of four patients, focusing particularly on the efficacy and complications of GKS. We reviewed the data of four patients with medically intractable epilepsy who underwent GKS between 1998 and 2000 at our hospital. The marginal dose to the 50% isodose line was 24 Gy in one patient and 20Gy in the remaining three patients. Two of the four patients were treated in the right temporal lobe, one was treated in the left parietal lobe, and one was treated in the right frontal lobe. The mean follow-up was 12.5 years (range 12-14 years). One patient was seizure free (Engel class IA) 24 months after GKS, and two patients failed to show any seizure reduction (Engel class IVA). However, a clear aggravation was evident in one patient (Engel class IVC). All four patients underwent resective surgery due to radiation necrosis (RN) 7, 10, 10 and 12 years after GKS. Three patients were seizure free (Engel class IA), and one was considered to have Engel class IB status following the resective surgery. GKS treatment resulted in insufficient seizure control and carried a significant risk of RN after several years. Drawbacks such as a delay in seizure control and the risk of RN should be considered when the clinical application of this treatment is evaluated.
Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
Ning
N
Chen
Clinical Medical Examination, The Sixth People Hospital of Jinan, Shandong, China.
Shou-Qin
SQ
Du
School of Public Health and Family Medicine, Capital Medical University, Beijing, China.
Na
N
Yan
Beijing Neurosurgical Institute, Capital Medical University, No. 6 Tiantan Xili, Dongcheng District, Beijing 100050, China.
Chong
C
Liu
Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
Jian-Guo
JG
Zhang
Beijing Neurosurgical Institute, Capital Medical University, No. 6 Tiantan Xili, Dongcheng District, Beijing 100050, China.
Yan
Y
Ge
Beijing Neurosurgical Institute, Capital Medical University, No. 6 Tiantan Xili, Dongcheng District, Beijing 100050, China. Electronic address: fgmeng@ccmu.edu.cn.
Fan-Gang
FG
Meng
D000328:Adult; D004827:Epilepsy / Q000473:pathology / Q000601:surgery*; D005500:Follow-Up Studies; D005625:Frontal Lobe / Q000473:pathology / Q000601:surgery; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D009336:Necrosis; D019635:Neurosurgical Procedures; D010296:Parietal Lobe / Q000473:pathology / Q000601:surgery; D016634:Radiosurgery / Q000009:adverse effects* / Q000379:methods; D013702:Temporal Lobe / Q000473:pathology / Q000601:surgery; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
Gamma Knife; Intractable epilepsy; Radiation necrosis; Radiosurgery