Visual field defects after radiosurgery for mesial temporal lobe epilepsy.
Visual field defects after radiosurgery for mesial temporal lobe epilepsy.
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DOI：
10.1111/epi.12215
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发表时间：
2013-08
期刊：
影响因子：
5.6
通讯作者：
Goodman R
中科院分区：
文献类型：
--
作者：
Hensley-Judge H;Quigg M;Barbaro NM;Newman SA;Ward MM;Chang EF;Broshek DK;Lamborn KR;Laxer KD;Garcia P;Heck CN;Kondziolka D;Beach R;Salanova V;Goodman R
伽玛刀放射外科（RS）可能是开放手术治疗内侧颞叶癫痫（MTLE）的替代方法，但RS的发病率和抗惊厥机制尚不清楚。RS后视野缺损（VFD）检查可提供术后固定病变范围的证据。52-100%的MTLE开放手术后患者发生VFD。这项RS的多中心前瞻性试验招募了单侧海马硬化和一致视频EEG结果的患者。患者被随机分配到杏仁核、海马头部和海马旁回接受低剂量（20 Gy）或高剂量（24 Gy）治疗。在RS后24个月获得术后视野检查结果。计算视野缺损率（VFDR）以量化VFD的程度。结果与年龄、RS剂量和50%等剂量体积、手术靶点放射诱导变化的峰值体积、生活质量测量和癫痫缓解进行对比。无患者报告视力变化，无患者床旁视野检查异常。24例患者中有15例（62.5%）术后发生VFD，均为正位上级象限盲。没有一个VFD与视神经、视交叉或视束损伤一致。VFD的临床诊断与VFDR显著相关（p=0.0005）。癫痫缓解患者的VFDR更小（更严重）（p=0.04）。没有其他变量具有显著相关性。RS后出现VFD的比例与MTLE开放手术的历史比较相似。VFD的性质与视放射病变一致。研究结果支持这一假设，RS的机制涉及一定程度的组织损伤，并不完全局限于神经调节功能的变化。
Gamma Knife radiosurgery (RS) may be an alternative to open surgery for mesial temporal lobe epilepsy (MTLE), but morbidities and the anticonvulsant mechanisms of RS are unclear. Examination of visual field defects (VFD) after RS may provide evidence of the extent of a postoperative fixed lesion. VFD occur in 52-100% of patients following open surgery for MTLE. This multicenter prospective trial of RS enrolled patients with unilateral hippocampal sclerosis and concordant video-EEG findings. Patients were randomized to low (20Gy) or high (24Gy) doses delivered to the amygdala, hippocampal head, and parahippocampal gyrus. Postoperative perimetry were obtained at 24 months after RS. Visual field defect ratios (VFDR) were calculated to quantify the degree of VFD. Results were contrasted with age, RS dose and 50% isodose volume, peak volume of radiation-induced change at the surgical target, quality of life measurements, and seizure remission. No patients reported visual changes and no patients had abnormal bedside visual field examinations. 15 of 24 patients (62.5%) had postoperative VFD, all homonymous superior quadrantanopsias. None of the VFDs were consistent with injury to the optic nerve, chiasm or tract. Clinical diagnosis of VFD correlated significantly with VFDR (p=0.0005). Patients with seizure remission had smaller (more severe) VFDR (p=0.04). No other variables had significant correlations. VFD appeared after RS in proportions similar to historical comparisons from open surgery for MTLE. The nature of VFD was consistent with lesions of the optic radiations. The findings support the hypothesis that the mechanism of RS involves some degree of tissue damage and is not confined entirely to functional changes in neuromodulation.
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影响因子：
2.9
作者：
Mengesha, T.;Abu-Ata, M.;Abou-Khalil, B. W.
通讯作者：
Abou-Khalil, B. W.
影响因子：
3.5
作者：
Nilsson, D;Malmgren, K;Frisén, L
通讯作者：
Frisén, L
影响因子：
2.2
作者：
Cramer, JA;Arrigo, C;Bromfield, EB
通讯作者：
Bromfield, EB
影响因子：
5.6
作者：
Quigg M;Rolston J;Barbaro NM
通讯作者：
Barbaro NM
影响因子：
4.1
作者：
Chen, ZF;Kamiryo, T;Lee, KS
通讯作者：
Lee, KS