What Role for Radiosurgery in Mesial Temporal Lobe Epilepsy

Summary

The Gamma Knife radiosurgery is a neurosurgical approach having now demonstrated well its efficiency, its low morbidity and its comfort in the treatment of numerous neurosurgical disorders. These advantages of this type of intervention make it a method of great interest in functional neurosurgery and quite particularly in surgery of epilepsy. French experience is a pioneer one in this domain.

Since for several years the positive evolution of the epilepsy associated with brain lesions had been noticed after radiosurgical Gamma Knife treatment, the use of this approach in surgery of epilepsy has been systematically evaluated since 1993. Data are today available concerning the surgical treatment of the epilepsies originating in the temporomesial area without space-occupying process, epilepsies associated to hypothalamic hamartomas and epilepsies associated with cavernous angiomas or low grade gliomas. The quality of the epileptological result obtained in these various indications associated with a very reduced morbidity lets assume that the Gamma Knife radiosurgery could indeed have tomorrow a place within the sample group of surgical approaches dedicated to the treatment of severe epilepsies.

However, a larger number of treated patients and a more prolonged follow-up remains necessary to assess this approach in a more definitive way.

Zusammenfassung:

Radiochirurgie mit dem Gamma Knife ist eine neurochirurgische Methode, die ihre Effizienz, eine niedrige Morbidität und geringeren Aufwand bei einer Anzahl neurochirurgischer Erkrankungen demonstriert hat. Die Vorteile dieser Art von Intervention machen diese Methode interessant für die funktionelle Neurochirurgie und besonders für die Chirurgie der Epilepsie. Die französischen Erfahrungen auf diesem Gebiet nehmen eine Pionierrolle ein.

Seitdem seit mehreren Jahren die positiven Effekte einer radiochirurgischen Gamma-Knife-Behandlung von Hirnläsionen auf die begleitenden Epilepsien bemerkt worden sind, ist der Gebrauch dieser Methode in der Epilepsiechirurgie systematisch seit 1993 evaluiert worden. Heute gibt es Befunde bezüglich der chirurgischen Behandlung von temporo-mesialen Epilepsien ohne raumfordernde Prozesse, bei Epilepsien verursacht durch hypothalamische Hamartome und bei Epilepsien hervorgerufen durch Cavernome und niedriggradige Gliome. Die Qualität der epileptologischen Ergebnisse, die bei diesen Indikationen erzielt werden konnten, lässt im Zusammenhang mit einer reduzierten Morbidität vermuten, dass die Gamma-Knife-Radiochirurgie in der Tat in der Zukunft einen Platz bei den denkbaren chirurgischen Therapieformen für die Behandlung schwerer Epilepsien haben könnte. Es sind jedoch noch eine größere Zahl von behandelten Patienten und längere Nachuntersuchungszeiträume erforderlich, um diese Behandlungsmodalität zuverlässiger zu beurteilen.

Key words:

Epilepsy - epilepsy surgery - radiosurgery gamma knife - temporal lobe epilepsy

Schlüsselwörter:

Epilepsie - Epilepsiechirurgie - Gamma-Knife-Radiochirurgie - Temporallappenepilepsie

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