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Stereotactic radiosurgery for medically refractory non-lesional epilepsy: A case-based Radiosurgery Society (RSS) practice review.
Daly, Samuel R; Soto, Jose M; Gonzalez, Sarah Mc; Ankrah, Nii; Gogineni, Emile; Andraos, Therese Y; Skalina, Karin A; Fekrmandi, Fatemeh; Quinn, Annette E; Romanelli, Pantaleo; Thomas, Evan; Danish, Shabbar.
Afiliación
  • Daly SR; Department of Neurological Surgery, Baylor Scott and White Health/Baylor College of Medicine, Temple, TX, United States. Electronic address: Samuel.Daly@bswhealth.org.
  • Soto JM; Department of Neurological Surgery, Baylor Scott and White Health/Baylor College of Medicine, Temple, TX, United States.
  • Gonzalez SM; Department of Neurological Surgery, Baylor Scott and White Health/Baylor College of Medicine, Temple, TX, United States.
  • Ankrah N; Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, AL, United States.
  • Gogineni E; Department of Radiation Oncology, The Ohio State University, Columbus, OH, United States.
  • Andraos TY; Department of Radiation Oncology, The Ohio State University, Columbus, OH, United States.
  • Skalina KA; Department of Radiation Oncology, Montefiore Medical Center, New York, NY, United States.
  • Fekrmandi F; Department of Radiation Oncology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States.
  • Quinn AE; Department of Radiation Oncology, University of Pittsburgh Medical Center Hillman Cancer Center, Pittsburgh, PA, United States.
  • Romanelli P; Cyberknife Center, Centro Diagnostico Italiano, Milan, Italy.
  • Thomas E; Department of Radiation Oncology, The Ohio State University, Columbus, OH, United States.
  • Danish S; Department of Neurosurgery, Jersey Shore University Medical Center, Neptune, NJ, United States.
Clin Neurol Neurosurg ; 246: 108550, 2024 Sep 11.
Article en En | MEDLINE | ID: mdl-39278006
ABSTRACT

INTRODUCTION:

Medically refractory epilepsy (MRE) occurs in about 30 % of patients with epilepsy, and the treatment options available to them have evolved over time. The classic treatment for medial temporal lobe epilepsy (mTLE) is anterior temporal lobectomy (ATL), but an initiative to find less invasive options has resulted in treatments such as neuromodulation, ablative procedures, and stereotactic radiosurgery (SRS). SRS has been an appealing non-invasive option and has developed an increasing presence in the literature over the last few decades. This article provides an overview of SRS for MRE with two example cases, and we discuss the optimal technique as well as the advantages, alternatives, and risks of this therapeutic option. CASES We present two example cases of patients with MRE, who were poor candidates for invasive surgical treatment options and underwent SRS. The first case is a 65-year-old female with multiple medical comorbidities, whose seizure focus was localized to the left temporal lobe, and the second case is a 19-year-old male with Protein C deficiency and medial temporal lobe sclerosis. Both patients underwent SRS to targets within the medial temporal lobe, and both achieve significant improvements in seizure frequency and severity.

DISCUSSION:

SRS has generally been shown to be inferior to ATL for seizure reduction in medically refractory mTLE. However, there are patients with epilepsy for which SRS can be considered, such as patients with medical comorbidities that make surgery high risk, patients with epileptogenic foci in eloquent cortex, patients who have failed to respond to surgical management, patients who choose not to undergo surgery, and patients with geographic constraints to epilepsy centers. Patients and their physicians should be aware that SRS is not risk-free. Patients should be counseled on the latency period and monitored for risks such as delayed cerebral edema, visual field deficits, and radiation necrosis.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: Clin Neurol Neurosurg Año: 2024 Tipo del documento: Article Pais de publicación: Países Bajos
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: Clin Neurol Neurosurg Año: 2024 Tipo del documento: Article Pais de publicación: Países Bajos