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Laskowski M, Błaszczyk B, Setlak M, Kuca M, Lech A, Kłos K, Rudnik A. Assessment of Radiation Dosage to the Hippocampi during Treatment of Multiple Brain Metastases Using Gamma Knife Therapy. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:246. [PMID: 38399534 PMCID: PMC10889917 DOI: 10.3390/medicina60020246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 01/15/2024] [Accepted: 01/28/2024] [Indexed: 02/25/2024]
Abstract
Background and Objectives: Brain metastases (BMs) pose significant clinical challenges in systemic cancer patients. They often cause symptoms related to brain compression and are typically managed with multimodal therapies, such as surgery, chemotherapy, whole brain radiotherapy (WBRT), and stereotactic radiosurgery (SRS). With modern oncology treatments prolonging survival, concerns about the neurocognitive side effects of BM treatments are growing. WBRT, though widely used for multiple BMs, has recognized neurocognitive toxicity. SRS, particularly Gamma Knife (GK) therapy, offers a minimally invasive alternative with fewer side effects, suitable for patients with a quantifiable number of metastases and better prognoses. Materials and Methods: A retrospective analysis was conducted on 94 patients with multiple BMs treated exclusively with GK at an academic medical center. Patients with prior WBRT were excluded. This study focused on the mean radiation dose received by the hippocampal area, estimated according to the 'Hippocampal Contouring: A Contouring Atlas for RTOG 0933' guidelines. Results: The precision of GK equipment results in mean doses of radiation that are lower than those suggested by RTOG 0933 and observed in other studies. This precision may help mitigate cognitive dysfunction and other side effects of hippocampal irradiation. Conclusions: GK therapy facilitates the administration of smaller, safer radiation doses to the hippocampi, which is advantageous even for lesions in the temporal lobe. It is feasible to treat multiple metastases, including cases with more than 10, but it is typically reserved for patients with fewer metastases, with an average of 3 in this study. This underlines GK's potential for reducing adverse effects while managing BMs effectively.
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Affiliation(s)
- Maciej Laskowski
- Student Scientific Society, Department of Neurosurgery, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-055 Katowice, Poland
| | - Bartłomiej Błaszczyk
- Department of Neurosurgery, University Clinical Center, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-752 Katowice, Poland
- Exira Gamma Knife, 40-952 Katowice, Poland
| | - Marcin Setlak
- Department of Neurosurgery, University Clinical Center, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-752 Katowice, Poland
| | - Maciej Kuca
- Student Scientific Society, Department of Neurosurgery, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-055 Katowice, Poland
| | | | - Kamil Kłos
- Student Scientific Society, Department of Neurosurgery, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-055 Katowice, Poland
| | - Adam Rudnik
- Department of Neurosurgery, University Clinical Center, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-752 Katowice, Poland
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Samalens L, Courivaud C, Adam JF, Barbier EL, Serduc R, Depaulis A. Innovative minimally invasive options to treat drug-resistant epilepsies. Rev Neurol (Paris) 2023:S0035-3787(23)01038-X. [PMID: 37798162 DOI: 10.1016/j.neurol.2023.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 03/20/2023] [Accepted: 05/14/2023] [Indexed: 10/07/2023]
Abstract
Despite the regular discovery of new molecules, one-third of epileptic patients are resistant to antiepileptic drugs. Only a few can benefit from resective surgery, the current gold standard. Although effective in 50-70% of cases, this therapy remains risky, costly, and can be associated with long-term cognitive or neurological side effects. In addition, patients are increasingly reluctant to have a craniotomy, emphasizing the need for new less invasive therapies for focal drug-resistant epilepsies. Here, we review different minimally invasive approaches already in use in the clinic or under preclinical development to treat drug-resistant epilepsies. Localized thermolesion of the epileptogenic zone has been developed in the clinic using high-frequency thermo-coagulations or magnetic resonance imaging-guided laser or ultrasounds. Although less invasive, they have not yet significantly improved the outcomes when compared with resective surgery. Radiosurgery techniques have been used in the clinic for the last 20years and have proven efficiency. However, their efficacy is not better than resective surgery, and various side effects have been reported as well as the potential risk of sudden unexpected death associated with epilepsy. Recently, a new strategy of radiosurgery has emerged using synchrotron-generated X-ray microbeams: microbeam radiation therapy (MRT). The low divergence and high-flux of the synchrotron beams and the unique tolerance to MRT by healthy brain tissues, allows a precise targeting of specific brain regions with minimal invasiveness and limited behavioral or functional consequences in animals. Antiepileptic effects over several months have been recorded in animal models, and histological and synaptic tracing analysis suggest a reduction of neuronal connectivity as a mechanism of action. The possibility of transferring this approach to epileptic patients is discussed in this review.
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Affiliation(s)
- L Samalens
- Université Grenoble-Alpes, Inserm, U1216, Grenoble Institut Neurosciences, 38000 Grenoble, France; Université Grenoble-Alpes, Inserm, UA7, STROBE, 38000 Grenoble, France
| | - C Courivaud
- Université Grenoble-Alpes, Inserm, U1216, Grenoble Institut Neurosciences, 38000 Grenoble, France
| | - J-F Adam
- Université Grenoble-Alpes, Inserm, UA7, STROBE, 38000 Grenoble, France; Centre Hospitalier Universitaire Grenoble-Alpes, 38700 La Tronche, France
| | - E L Barbier
- Université Grenoble-Alpes, Inserm, U1216, Grenoble Institut Neurosciences, 38000 Grenoble, France
| | - R Serduc
- Université Grenoble-Alpes, Inserm, UA7, STROBE, 38000 Grenoble, France
| | - A Depaulis
- Université Grenoble-Alpes, Inserm, U1216, Grenoble Institut Neurosciences, 38000 Grenoble, France.
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Treiber JM, Bayley JC, Curry D. Minimally Invasive Destructive, Ablative, and Disconnective Epilepsy Surgery. JOURNAL OF PEDIATRIC EPILEPSY 2023. [DOI: 10.1055/s-0042-1760106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
AbstractConventional epilepsy surgery performed by microsurgical dissection typically requires large cranial working windows created with high-speed drills and lengthy incisions. In the past few decades, minimally invasive techniques have been developed with smaller incisions, comparable efficacy, shorter hospitalizations, and better safety profiles. These minimally invasive alternatives utilize stereotactic, ultrasonic, radiotherapeutic, and endoscopic techniques. Although not able to completely replace conventional surgery for all etiologies of epilepsy, these minimally invasive techniques have revolutionized modern epilepsy surgery and have been an invaluable asset to the neurosurgeon's repertoire. The endoscope has allowed for surgeons to have adequate visualization during resective and disconnective epilepsy surgeries using keyhole or miniature craniotomies. Modern stereotactic techniques such as laser interstitial thermal therapy and radiofrequency ablation can be used as viable alternatives for mesial temporal lobe epilepsy and can destroy lesional tissue deep areas without the approach-related morbidity of microsurgery such as with hypothalamic hamartomas. These stereotactic techniques do not preclude future surgery in the settings of treatment failure and have been used successfully after failed conventional surgery. Multiple ablation corridors can be performed in a single procedure that can be used for lesioning of large targets or to simplify treating multifocal epilepsies. These stereotactic techniques have even been used successfully to perform disconnective procedures such as hemispherotomies and corpus callosotomies. In patients unable to tolerate surgery, stereotactic radiosurgery is a minimally invasive option that can result in improved seizure control with minimal procedural risks. Advances in minimally invasive neurosurgery provide viable treatment options for drug-resistant epilepsy with quicker recovery, less injury to functional brain, and for patients that may otherwise not choose conventional surgery.
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Affiliation(s)
- Jeffrey M. Treiber
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, United States
- Division of Pediatric Neurosurgery, Department of Surgery, Texas Children's Hospital, Houston, Texas, United States
| | - James C. Bayley
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, United States
- Division of Pediatric Neurosurgery, Department of Surgery, Texas Children's Hospital, Houston, Texas, United States
| | - Daniel Curry
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, United States
- Division of Pediatric Neurosurgery, Department of Surgery, Texas Children's Hospital, Houston, Texas, United States
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Non-Oncological Radiotherapy: A Review of Modern Approaches. J Pers Med 2022; 12:jpm12101677. [PMID: 36294816 PMCID: PMC9605240 DOI: 10.3390/jpm12101677] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 10/04/2022] [Accepted: 10/06/2022] [Indexed: 11/05/2022] Open
Abstract
Despite being usually delivered in oncological patients, radiotherapy can be used as a successful treatment for several non-malignant disorders. Even though this use of radiotherapy has been scarcely investigated since the 1950s, more recent interest has actually shed the light on this approach. Thus, the aim of this narrative review is to analyze the applications of non-oncological radiotherapy in different disorders. Key references were derived from a PubMed query. Hand searching and clinicaltrials.gov were also used. This review contains a narrative report and a critical discussion of non-oncological radiotherapy approaches. In conclusion, non-oncological radiotherapy is a safe and efficacious approach to treat several disorders that needs to be further investigated and used in clinical practice.
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Magnetic Resonance–Guided Laser Interstitial Thermal Therapy Versus Stereotactic Radiosurgery for Medically Intractable Temporal Lobe Epilepsy: A Systematic Review and Meta-Analysis of Seizure Outcomes and Complications. World Neurosurg 2019; 122:e32-e47. [DOI: 10.1016/j.wneu.2018.08.227] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 08/29/2018] [Accepted: 08/31/2018] [Indexed: 11/23/2022]
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Barbaro NM, Quigg M, Ward MM, Chang EF, Broshek DK, Langfitt JT, Yan G, Laxer KD, Cole AJ, Sneed PK, Hess CP, Yu W, Tripathi M, Heck CN, Miller JW, Garcia PA, McEvoy A, Fountain NB, Salanova V, Knowlton RC, Bagić A, Henry T, Kapoor S, McKhann G, Palade AE, Reuber M, Tecoma E. Radiosurgery versus open surgery for mesial temporal lobe epilepsy: The randomized, controlled ROSE trial. Epilepsia 2018; 59:1198-1207. [PMID: 29600809 DOI: 10.1111/epi.14045] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To compare stereotactic radiosurgery (SRS) versus anterior temporal lobectomy (ATL) for patients with pharmacoresistant unilateral mesial temporal lobe epilepsy (MTLE). METHODS This randomized, single-blinded, controlled trial recruited adults eligible for open surgery among 14 centers in the USA, UK, and India. Treatment was either SRS at 24 Gy to the 50% isodose targeting mesial structures, or standardized ATL. Outcomes were seizure remission (absence of disabling seizures between 25 and 36 months), verbal memory (VM), and quality of life (QOL) at 36-month follow-up. RESULTS A total of 58 patients (31 in SRS, 27 in ATL) were treated. Sixteen (52%) SRS and 21 (78%) ATL patients achieved seizure remission (difference between ATL and SRS = 26%, upper 1-sided 95% confidence interval = 46%, P value at the 15% noninferiority margin = .82). Mean VM changes from baseline for 21 English-speaking, dominant-hemisphere patients did not differ between groups; consistent worsening occurred in 36% of SRS and 57% of ATL patients. QOL improved with seizure remission. Adverse events were anticipated cerebral edema and related symptoms for some SRS patients, and cerebritis, subdural hematoma, and others for ATL patients. SIGNIFICANCE These data suggest that ATL has an advantage over SRS in terms of proportion of seizure remission, and both SRS and ATL appear to have effectiveness and reasonable safety as treatments for MTLE. SRS is an alternative to ATL for patients with contraindications for or with reluctance to undergo open surgery.
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Affiliation(s)
- Nicholas M Barbaro
- Department of Neurological Surgery, Indiana University, Indianapolis, IN, USA
| | - Mark Quigg
- Department of Neurology, University of Virginia, Charlottesville, VA, USA
| | - Mariann M Ward
- Department of Neurosurgery, University of California San Francisco, San Francisco, CA, USA
| | - Edward F Chang
- Department of Neurosurgery, University of California San Francisco, San Francisco, CA, USA
| | - Donna K Broshek
- Department of Psychiatry, University of Virginia, Charlottesville, VA, USA
| | - John T Langfitt
- Department of Neurology, University of Rochester, Rochester, NY, USA
| | - Guofen Yan
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA
| | - Kenneth D Laxer
- Department of Neurology, California Pacific Medical Center, San Francisco, CA, USA
| | - Andrew J Cole
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Penny K Sneed
- Department of Radiation Oncology, University of California San Francisco, San Francisco, CA, USA
| | - Christopher P Hess
- Department of Radiology, University of California San Francisco, San Francisco, CA, USA
| | - Wei Yu
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA
| | - Manjari Tripathi
- Department of Neurology, All India Institute of Medical Science, New Delhi, India
| | - Christianne N Heck
- Department of Neurology, University of Southern California, Los Angeles, CA, USA
| | - John W Miller
- Department of Neurology, University of Washington, Seattle, WA, USA
| | - Paul A Garcia
- Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - Andrew McEvoy
- Department of Clinical and Experimental Epilepsy, University College London, London, UK
| | - Nathan B Fountain
- Department of Neurology, University of Virginia, Charlottesville, VA, USA
| | | | - Robert C Knowlton
- Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - Anto Bagić
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Thomas Henry
- Department of Neurology, University of Minnesota, Minneapolis, MN, USA
| | - Siddharth Kapoor
- Department of Neurology, University of Kentucky, Lexington, KY, USA
| | - Guy McKhann
- Department of Neurosurgery, Columbia University, New York, NY, USA
| | - Adriana E Palade
- Department of Neurology, University of Louisville, Louisville, KY, USA
| | - Markus Reuber
- Department of Neuroscience, University of Sheffield, Sheffield, UK
| | - Evelyn Tecoma
- Department of Neurology, University of California San Diego, San Diego, CA, USA
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Eekers DB, Pijnappel EN, Schijns OE, Colon A, Hoeben A, Zindler JD, Postma AA, Hoffmann AL, Lambin P, Troost EG. Evidence on the efficacy of primary radiosurgery or stereotactic radiotherapy for drug-resistant non-neoplastic focal epilepsy in adults: A systematic review. Seizure 2018; 55:83-92. [DOI: 10.1016/j.seizure.2018.01.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 01/09/2018] [Accepted: 01/11/2018] [Indexed: 12/28/2022] Open
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Radiosurgery for epilepsy: Systematic review and International Stereotactic Radiosurgery Society (ISRS) practice guideline. Epilepsy Res 2017; 137:123-131. [DOI: 10.1016/j.eplepsyres.2017.08.016] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2017] [Accepted: 08/27/2017] [Indexed: 10/18/2022]
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Feng ES, Sui CB, Wang TX, Sun GL. Stereotactic radiosurgery for the treatment of mesial temporal lobe epilepsy. Acta Neurol Scand 2016; 134:442-451. [PMID: 26846702 DOI: 10.1111/ane.12562] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/29/2015] [Indexed: 12/01/2022]
Abstract
OBJECTIVES Stereotactic radiosurgery (RS) is a potential option for some patients with temporal lobe epilepsy (TLE). The aim of this meta-analysis was to determine the pooled seizure-free rate and the time interval to seizure cessation in patients with lesions in the mesial temporal lobe, and who were eligible for either stereotactic or gamma knife RS. MATERIALS & METHODS We searched the Medline, Cochrane, EMBASE, and Google Scholar databases using combinations of the following terms: RS, stereotactic radiosurgery, gamma knife, and TLE. RESULTS We screened 103 articles and selected 13 for inclusion in the meta-analysis. Significant study heterogeneity was detected; however, the included studies displayed an acceptable level of quality. We show that approximately half of the patients were seizure free over a follow-up period that ranged from 6 months to 9 years [pooled estimate: 50.9% (95% confidence interval: 0.381-0.636)], with an average of 14 months to seizure cessation [pooled estimate: 14.08 months (95% confidence interval: 11.95-12.22 months)]. Nine of 13 included studies reported data for adverse events (AEs), which included visual field deficits and headache (the two most common AEs), verbal memory impairment, psychosis, psychogenic non-epileptic seizures, and dysphasia. Patients in the individual studies experienced AEs at rates that ranged from 8%, for non-epileptic seizures, to 85%, for headache. CONCLUSION Our findings indicate that RS may have similar or slightly less efficacy in some patients compared with invasive surgery. Randomized controlled trials of both treatment regimens should be undertaken to generate an evidence base for patient decision-making.
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Affiliation(s)
- E.-S. Feng
- Department of Neurosurgery; Beijing Ditan Hospital; Capital Medical University; Beijing China
| | - C.-B. Sui
- Department of Neurology; Beihai Hospital; Yantai Shandong China
| | - T.-X. Wang
- Department of Neurosurgery; Yidu Central Hospital of Weifang; Weifang Shandong China
| | - G.-L. Sun
- Department of Neurosurgery; Yidu Central Hospital of Weifang; Weifang Shandong China
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Zhang L, Liang S, Zhang G, Liu Z, Lv H, Fang F, Wang Y, Zhang S, Kang X. Seizure control of current shunt on rats with temporal lobe epilepsy and neocortical epilepsy. PLoS One 2014; 9:e86477. [PMID: 24497949 PMCID: PMC3907408 DOI: 10.1371/journal.pone.0086477] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Accepted: 12/09/2013] [Indexed: 11/18/2022] Open
Abstract
Purpose To examine the effects of current shunt on rats with temporal lobe epilepsy and neocortex epilepsy. Experimental Design A kainic acid (KA)-induced model of temporal lobe seizure and a penicillin-induced model of neocortical partial seizure were used in this study. Rats of each model were randomly allocated into two groups: control and model groups. The model group was further divided into the KA or penicillin group, sham conduction group and conduction group. The current shunt was realized through the implantation of a customized conduction electrode. After surgery, electroencephalogram (EEG) was recorded for two hours for each rat under anesthesia. Subsequently, the rats were video monitored for 72 h to detect the occurrence of behavioral seizures upon awakening. The average number and duration of seizures on EEG and the number of behavioral seizures were measured. Results In KA model, the number of total EEG seizures in conduction group (9.57±2.46) was significantly less than that in sham conduction group (15.13±3.45) (p<0.01). The duration of EEG seizures in conduction group (26.13±7.81 s) was significantly shorter than that in sham conduction group (34.17±7.25 s) (p = 0.001). A significant reduction of behavioral seizures was observed in the conduction group compared with KA (p = 0.000) and sham conduction groups (p = 0.000). In penicillin model, there was a 61% reduction in total EEG seizures in conduction group compared with sham conduction group (p<0.01), and the duration of EEG seizures in conduction group (6.29±2.64 s) was significantly shorter than that in the sham conduction group (12.07±3.81 s) (p = 0.002). A significant reduction of behavioral seizures was observed in conduction group compared with penicillin (p<0.01) and sham conduction groups (p<0.01). Conclusion Current shunt effectively reduces the onset and severity of seizures. Current shunt therapy could be an effective alternative minimally invasive approach for temporal lobe epilepsy and neocortex epilepsy.
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Affiliation(s)
- Limin Zhang
- Laboratory Diagnosis Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Department of Neurosurgery, Capital Epilepsy Therapy Center, First Affiliated Hospital of Chinese People's Liberation Army General Hospital, Beijing, China
| | - Shuli Liang
- Department of Neurosurgery, Capital Epilepsy Therapy Center, First Affiliated Hospital of Chinese People's Liberation Army General Hospital, Beijing, China
- * E-mail: (SL); (XK)
| | - Guojun Zhang
- Laboratory Diagnosis Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Zhizhong Liu
- Laboratory Diagnosis Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Hong Lv
- Laboratory Diagnosis Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Fang Fang
- Laboratory Diagnosis Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yajie Wang
- Laboratory Diagnosis Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Shaohui Zhang
- Department of Neurosurgery, Capital Epilepsy Therapy Center, First Affiliated Hospital of Chinese People's Liberation Army General Hospital, Beijing, China
| | - Xixiong Kang
- Laboratory Diagnosis Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- * E-mail: (SL); (XK)
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Wu C, Sperling MR, Falowski SM, Chitale AV, Werner-Wasik M, Evans JJ, Andrews DW, Sharan AD. Radiosurgery for the treatment of dominant hemisphere periventricular heterotopia and intractable epilepsy in a series of three patients. EPILEPSY & BEHAVIOR CASE REPORTS 2012; 1:1-6. [PMID: 25688044 PMCID: PMC4150677 DOI: 10.1016/j.ebcr.2012.10.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/03/2012] [Accepted: 10/06/2012] [Indexed: 11/26/2022]
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.
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Affiliation(s)
- Chengyuan Wu
- Thomas Jefferson University Hospitals, Department of Neurological Surgery, 909 Walnut Street, Third Floor, Philadelphia, PA, USA
| | - Michael R Sperling
- Thomas Jefferson University, Department of Neurology, Philadelphia, PA, USA
| | - Steven M Falowski
- Thomas Jefferson University, Department of Neurological Surgery, Philadelphia, PA, USA
| | - Ameet V Chitale
- Thomas Jefferson University, Department of Neurological Surgery, Philadelphia, PA, USA
| | - Maria Werner-Wasik
- Thomas Jefferson University, Department of Radiation Oncology, Philadelphia, PA, USA
| | - James J Evans
- Thomas Jefferson University, Department of Neurological Surgery, Philadelphia, PA, USA
| | - David W Andrews
- Thomas Jefferson University, Department of Neurological Surgery, Philadelphia, PA, USA
| | - Ashwini D Sharan
- Thomas Jefferson University, Department of Neurological Surgery, Philadelphia, PA, USA
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Rauch C, Semrau S, Fietkau R, Rampp S, Kasper B, Stefan H. Long-term experience with fractionated stereotactic radiotherapy in pharmacoresistant epilepsy: Neurological and MRI changes. Epilepsy Res 2012; 99:14-20. [DOI: 10.1016/j.eplepsyres.2011.10.036] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2011] [Accepted: 10/30/2011] [Indexed: 10/14/2022]
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