Stereotactic radiosurgery for the treatment of mesial temporal lobe epilepsy

Feng, Enshan; Sui, Chengguang; Wang, T.-X.; Sun, Gaoling

doi:10.1111/ane.12562

Cited by 19 publications

(17 citation statements)

References 38 publications

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“…Indeed, Régis et al ’s small multicentre European study using single fraction gamma knife in patients with hippocampal sclerosis who had similarly decided against conventional surgery—which was towards the end of recruitment when our patient received her treatment—reported transient increases in seizure activity in all patients after 9–12 months before a universal decrease, with overall seizure freedom in 65% at 2 years 2. A recent meta-analysis of radiosurgery techniques (X-rays or gamma radiation) in patients with hippocampal sclerosis not offered open surgery found this group’s seizure freedom rates were almost as good as with temporal lobe resection, albeit after a 14-month mean delay 3. However, there are no randomised clinical trials directly comparing efficacy and side effect profiles of invasive versus non-invasive surgical methods.…”

Section: Discussionmentioning

confidence: 82%

Intracranial papillary endothelial hyperplasia (Masson’s tumour) following gamma knife radiosurgery for temporal lobe epilepsy

et al. 2017

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We present a rare case of intracranial papillary endothelial hyperplasia, or 'Masson's tumour,' following gamma knife radiosurgery for epilepsy. A 59-year-old woman presented with a 4-month history of escalating headaches and progressive neurological deficit. MR scan of brain showed enlargement of an enhancing right temporal lobe lesion, midline shift and obstructive hydrocephalus. She had previously undergone non-curative gamma knife radiosurgery at the age of 44 years for medically refractory complex partial seizures. Postprocedure imaging had shown signal change and enhancement within the right temporal lobe consistent with radiation necrosis, which remained stable over the next decade. Now, 15 years following radiosurgery, we suspected an intrinsic high-grade neoplasm, but surgical excision instead found a benign pseudoneoplasm. Papillary endothelial hyperplasia should be considered in the differential diagnosis for mass lesions following gamma knife radiosurgery, particularly as resection can be curative. Remarkably, she has become seizure free.

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Section: Discussionmentioning

confidence: 82%

Intracranial papillary endothelial hyperplasia (Masson’s tumour) following gamma knife radiosurgery for temporal lobe epilepsy

et al. 2017

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“…In a retrospective medical record review of a subset of 68 patients enrolled in a large prospective observational study of epilepsy surgery, there were 0.04 hospitalizations per patient‐year in patients who were seizure‐free after ATL, compared to 0.25 hospitalizations per patient‐year among surgical and nonsurgical patients with persistent seizures . In a recent meta‐analysis, the pooled estimate of seizure‐free outcome after SRS was 51% (95% CI = 38%‐64%) . The most common AE was headache, which occurred in 9%‐85% of series in which it was reported (median = 43%).…”

Section: Discussionmentioning

confidence: 99%

Direct and indirect costs associated with stereotactic radiosurgery or open surgery for medial temporal lobe epilepsy: Results from the ROSE trial

et al. 2019

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Objective To determine whether a less‐invasive approach to surgery for medically refractory temporal lobe epilepsy is associated with lower health care costs and costs of lost productivity over time, compared to open surgery. Methods We compared direct medical costs and indirect productivity costs associated with treatment with stereotactic radiosurgery (SRS) or anterior temporal lobectomy (ATL) in the ROSE (Radiosurgery or Open Surgery for Epilepsy) trial. Health care use was abstracted from hospital bills, the study database, and diaries in which participants recorded health care use and time lost from work while seeking care. Costs of use were calculated using a Medicare costing approach used in a prior study of the costs of ATL. The power of many analyses was limited by the sample size and data skewing. Results Combined treatment and follow‐up costs (in thousands of US dollars) did not differ between SRS (n = 20, mean = $76.6, 95% confidence interval [CI] = 50.7‐115.6) and ATL (n = 18, mean = $79.0, 95% CI = 60.09‐103.8). Indirect costs also did not differ. More ATL than SRS participants were free of consciousness‐impairing seizures in each year of follow‐up (all P < 0.05). Costs declined following ATL (P = 0.005). Costs tended to increase over the first 18 months following SRS (P = 0.17) and declined thereafter (P = 0.06). This mostly reflected hospitalizations for SRS‐related adverse events in the second year of follow‐up. Significance Lower initial costs of SRS for medial temporal lobe epilepsy were largely offset by hospitalization costs related to adverse events later in the course of follow‐up. Future studies of less‐invasive alternatives to ATL will need to assess adverse events and major costs systematically and prospectively to understand the economic implications of adopting these technologies.

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“…A recent meta-analysis of stereotactic radiosurgery for mesial temporal sclerosis [166] showed that the total number of patients reported remains low (<200) but that half became seizure free at a median of 14 months after treatment with a complication rate of around 8% (excluding headache which was more common) and rates of visual field defects similar to open surgery. MRI-guided laser thermocoagulation has been undertaken in a few patient with initially promising results.…”

Section: Epilepsy Surgerymentioning

confidence: 99%

Recent advances in epilepsy

2017

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This paper reviews advances in epilepsy in recent years with an emphasis on therapeutics and underlying mechanisms, including status epilepticus, drug and surgical treatments. Lessons from rarer epilepsies regarding the relationship between epilepsy type, mechanisms and choice of antiepileptic drugs (AED) are explored and data regarding AED use in pregnancy are reviewed. Concepts evolving towards a move from treating seizures to treating epilepsy are discussed, both in terms of the mechanisms of epileptogenesis, and in terms of epilepsy’s broader comorbidity, especially depression.

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Stereotactic radiosurgery for the treatment of mesial temporal lobe epilepsy

Abstract: 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.

Cited by 19 publications

References 38 publications

Intracranial papillary endothelial hyperplasia (Masson’s tumour) following gamma knife radiosurgery for temporal lobe epilepsy

Intracranial papillary endothelial hyperplasia (Masson’s tumour) following gamma knife radiosurgery for temporal lobe epilepsy

Direct and indirect costs associated with stereotactic radiosurgery or open surgery for medial temporal lobe epilepsy: Results from the ROSE trial

Recent advances in epilepsy

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