title: Radiosurgery for the treatment of dominant hemisphere periventricular heterotopia and intractable epilepsy in a series of three patients.
abstract: Periventricular heterotopia (PVH) is a neuronal migration disorder characterized by masses of gray matter located along the lateral ventricles that commonly cause epilepsy. The benefit of surgical resection of the PVH has been demonstrated in case reports to date; however, the location of the PVH in the paratrigonal region of the lateral ventricles can present significant surgical challenges. Noninvasive modalities of ablating this epileptogenic focus must therefore be considered. We present a small series of three patients who underwent stereotactic radiosurgery (SRS) for inoperable unilateral dominant hemisphere PVHs in order to illustrate the potential benefits and risks of this treatment modality. A total dose of 37.5-65 Gy resulted in seizure freedom for at least 14 months at the time of their last follow-up, even in patients harboring a second independent epileptic focus. Whether intracranial electrode recording truly offers added value is therefore uncertain. The two patients who received higher radiation doses suffered from symptomatic radiation necrosis and associated cerebral edema, requiring further medical intervention, and persistent monocular visual loss in one patient. While a longer interval prior to re-treatment may have been attempted, neither patient demonstrated radiographic findings typically associated with seizure remission. Refractory epilepsy due to PVH may be successfully treated with radiation therapy; but further work is needed to define the optimal dosing parameters in order to lower toxicity to normal tissue.
authors: Thomas Jefferson University Hospitals, Department of Neurological Surgery, 909 Walnut Street, Third Floor, Philadelphia, PA, USA.
authors: Chengyuan
authors: C
authors: Wu
authors: Thomas Jefferson University, Department of Neurology, Philadelphia, PA, USA.
authors: Michael R
authors: MR
authors: Sperling
authors: Thomas Jefferson University, Department of Neurological Surgery, Philadelphia, PA, USA.
authors: Steven M
authors: SM
authors: Falowski
authors: Thomas Jefferson University, Department of Neurological Surgery, Philadelphia, PA, USA.
authors: Ameet V
authors: AV
authors: Chitale
authors: Thomas Jefferson University, Department of Radiation Oncology, Philadelphia, PA, USA.
authors: Maria
authors: M
authors: Werner-Wasik
authors: Thomas Jefferson University, Department of Neurological Surgery, Philadelphia, PA, USA.
authors: James J
authors: JJ
authors: Evans
authors: Thomas Jefferson University, Department of Neurological Surgery, Philadelphia, PA, USA.
authors: David W
authors: DW
authors: Andrews
authors: Thomas Jefferson University, Department of Neurological Surgery, Philadelphia, PA, USA.
authors: Ashwini D
authors: AD
authors: Sharan
keywords: Epilepsy; Periventricular nodular heterotopia (PVH); Radionecrosis; Stereotactic radiosurgery (SRS)