Delayed complication after Gamma Knife surgery for mesial temporal lobe epilepsy

Clinical article

Kenichi Usami M.D. 1 , Kensuke Kawai M.D., Ph.D. 1 , Tomoyuki Koga M.D., Ph.D. 1 , Masahiro Shin M.D., Ph.D. 1 , Hiroki Kurita M.D., Ph.D. 2 , Ichiro Suzuki M.D., Ph.D. 3 , and Nobuhito Saito M.D., Ph.D. 1
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  • 1 Department of Neurosurgery, The University of Tokyo Hospital, Tokyo;
  • 2 Department of Cerebrovascular Surgery, Saitama Medical University International Medical Center, Saitama; and
  • 3 Department of Neurosurgery, Japanese Red Cross Medical Center, Tokyo, Japan
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Object

Despite the controversy over the clinical significance of Gamma Knife surgery (GKS) for refractory mesial temporal lobe epilepsy (MTLE), the modality has attracted attention because it is less invasive than resection. The authors report long-term outcomes for 7 patients, focusing in particular on the long-term complications.

Methods

Between 1996 and 1999, 7 patients with MTLE underwent GKS. The 50% marginal dose covering the medial temporal structures was 18 Gy in 2 patients and 25 Gy in the remaining 5 patients.

Results

High-dose treatment abolished the seizures in 2 patients and significantly reduced them in 2 others. One patient in this group was lost to follow-up. However, 2 patients presented with symptomatic radiation necrosis (SRN) necessitating resection after 5 and 10 years. One patient who did not need necrotomy continued to show radiation necrosis on MRI after 10 years. One patient died of drowning while swimming in the sea 1 year after GKS, before seizures had disappeared completely.

Conclusions

High-dose treatment resulted in sufficient seizure control but carried a significant risk of SRN after several years. Excessive target volume was considered as a reason for delayed necrosis. Drawbacks such as a delay in seizure control and the risk of SRN should be considered when the clinical significance of this treatment is evaluated.

Abbreviations used in this paper:AVM = arteriovenous malformation; CPS = complex partial seizure; GKS = Gamma Knife surgery; MTLE = mesial temporal lobe epilepsy; SRN = symptomatic radiation necrosis.

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Contributor Notes

Address correspondence to: Kenichi Usami, M.D., Department of Neurosurgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan. email: usaken-tky@umin.ac.jp.

Please include this information when citing this paper: published online March 23, 2012; DOI: 10.3171/2012.2.JNS111296.

  • 1

    Barbaro NM, , Quigg M, , Broshek DK, , Ward MM, , Lamborn KR, & Laxer KD, : A multicenter, prospective pilot study of gamma knife radiosurgery for mesial temporal lobe epilepsy: seizure response, adverse events, and verbal memory. Ann Neurol 65:167175, 2009

    • Search Google Scholar
    • Export Citation
  • 2

    Bartolomei F, , Hayashi M, , Tamura M, , Rey M, , Fischer C, & Chauvel P, : Long-term efficacy of gamma knife radiosurgery in mesial temporal lobe epilepsy. Neurology 70:16581663, 2008

    • Search Google Scholar
    • Export Citation
  • 3

    Chang EF, , Quigg M, , Oh MC, , Dillon WP, , Ward MM, & Laxer KD, : Predictors of efficacy after stereotactic radiosurgery for medial temporal lobe epilepsy. Neurology 74:165172, 2010

    • Search Google Scholar
    • Export Citation
  • 4

    Cmelak AJ, , Abou-Khalil B, , Konrad PE, , Duggan D, & Maciunas RJ: Low-dose stereotactic radiosurgery is inadequate for medically intractable mesial temporal lobe epilepsy: a case report. Seizure 10:442446, 2001

    • Search Google Scholar
    • Export Citation
  • 5

    De Riu PL, & Rocca A: Interstitial irradiation therapy of supratentorial gliomas by stereotaxic technique. Long term results. Ital J Neurol Sci 9:243248, 1988

    • Search Google Scholar
    • Export Citation
  • 6

    Engel J Jr, , Wiebe S, , French J, , Sperling M, , Williamson P, & Spencer D, : Practice parameter: temporal lobe and localized neocortical resections for epilepsy: report of the Quality Standards Subcommittee of the American Academy of Neurology, in association with the American Epilepsy Society and the American Association of Neurological Surgeons. Neurology 60:538547, 2003

    • Search Google Scholar
    • Export Citation
  • 7

    Flickinger JC, , Schell MC, & Larson DA: Estimation of complications for linear accelerator radiosurgery with the integrated logistic formula. Int J Radiat Oncol Biol Phys 19:143148, 1990

    • Search Google Scholar
    • Export Citation
  • 8

    Foroughi M, , Kemeny AA, , Lehecka M, , Wons J, , Kajdi L, & Hatfield R, : Operative intervention for delayed symptomatic radionecrotic masses developing following stereotactic radiosurgery for cerebral arteriovenous malformations—case analysis and literature review. Acta Neurochir (Wien) 152:803815, 2010

    • Search Google Scholar
    • Export Citation
  • 9

    Friehs GM, , Park MC, , Goldman MA, , Zerris VA, , Norén G, & Sampath P: Stereotactic radiosurgery for functional disorders. Neurosurg Focus 23:6 E3, 2007

    • Search Google Scholar
    • Export Citation
  • 10

    Heikkinen ER, , Konnov B, , Melnikov L, , Yalynych N, , Zubkov YN, & Garmashov YA, : Relief of epilepsy by radiosurgery of cerebral arteriovenous malformations. Stereotact Funct Neurosurg 53:157166, 1989

    • Search Google Scholar
    • Export Citation
  • 11

    Kawai K, , Suzuki I, , Kurita H, , Shin M, , Arai N, & Kirino T: Failure of low-dose radiosurgery to control temporal lobe epilepsy. J Neurosurg 95:883887, 2001

    • Search Google Scholar
    • Export Citation
  • 12

    Kjellberg RN, , Hanamura T, , Davis KR, , Lyons SL, & Adams RD: Bragg-peak proton-beam therapy for arteriovenous malformations of the brain. N Engl J Med 309:269274, 1983

    • Search Google Scholar
    • Export Citation
  • 13

    Okun MS, , Stover NP, , Subramanian T, , Gearing M, , Wainer BH, & Holder CA, : Complications of gamma knife surgery for Parkinson disease. Arch Neurol 58:19952002, 2001

    • Search Google Scholar
    • Export Citation
  • 14

    Oyoshi T, , Hirahara K, , Uetsuhara K, , Yatsushiro K, & Arita K: Delayed radiation necrosis 7 years after gamma knife surgery for arteriovenous malformation—two case reports. Neurol Med Chir (Tokyo) 50:6266, 2010

    • Search Google Scholar
    • Export Citation
  • 15

    Régis J, , Bartolomei F, , Rey M, , Genton P, , Dravet C, & Semah F, : Gamma knife surgery for mesial temporal lobe epilepsy. Epilepsia 40:15511556, 1999

    • Search Google Scholar
    • Export Citation
  • 16

    Régis J, , Peragui JC, , Rey M, , Samson Y, , Levrier O, & Porcheron D, : First selective amygdalohippocampal radiosurgery for ‘mesial temporal lobe epilepsy’. Stereotact Funct Neurosurg 64:Suppl 1 193201, 1995

    • Search Google Scholar
    • Export Citation
  • 17

    Rheims S, , Fischer C, , Ryvlin P, , Isnard J, , Guenot M, & Tamura M, : Long-term outcome of gamma-knife surgery in temporal lobe epilepsy. Epilepsy Res 80:2329, 2008

    • Search Google Scholar
    • Export Citation
  • 18

    Rogers LR, , Morris HH, & Lupica K: Effect of cranial irradiation on seizure frequency in adults with low-grade astrocytoma and medically intractable epilepsy. Neurology 43:15991601, 1993

    • Search Google Scholar
    • Export Citation
  • 19

    Rossi GF, , Scerrati M, & Roselli R: Epileptogenic cerebral low-grade tumors: effect of interstitial stereotactic irradiation on seizures. Appl Neurophysiol 48:127132, 1985

    • Search Google Scholar
    • Export Citation
  • 20

    Spencer SS, , Berg AT, , Vickrey BG, , Sperling MR, , Bazil CW, & Shinnar S, : Predicting long-term seizure outcome after resective epilepsy surgery: the multicenter study. Neurology 65:912918, 2005

    • Search Google Scholar
    • Export Citation
  • 21

    Srikijvilaikul T, , Najm I, , Foldvary-Schaefer N, , Lineweaver T, , Suh JH, & Bingaman WE: Failure of gamma knife radiosurgery for mesial temporal lobe epilepsy: report of five cases. Neurosurgery 54:13951404, 2004

    • Search Google Scholar
    • Export Citation
  • 22

    Vojtech Z, , Vladyka V, , Kalina M, , Nespor E, , Seltenreichová K, & Semnická J, : The use of radiosurgery for the treatment of mesial temporal lobe epilepsy and long-term results. Epilepsia 50:20612071, 2009

    • Search Google Scholar
    • Export Citation
  • 23

    Wiebe S, , Blume WT, , Girvin JP, & Eliasziw M: A randomized, controlled trial of surgery for temporal-lobe epilepsy. N Engl J Med 345:311318, 2001

    • Search Google Scholar
    • Export Citation
  • 24

    Yamamoto M, , Hara M, , Ide M, , Ono Y, , Jimbo M, & Saito I: Radiation-related adverse effects observed on neuro-imaging several years after radiosurgery for cerebral arteriovenous malformations. Surg Neurol 49:385398, 1998

    • Search Google Scholar
    • Export Citation

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