Long-term outcome of gamma-knife surgery in temporal lobe epilepsy
Long-term outcome of gamma-knife surgery in temporal lobe epilepsy
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DOI：
10.1016/j.eplepsyres.2008.03.003
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发表时间：
2008-07-01
影响因子：
2.2
通讯作者：
Mauguiere, Francois
中科院分区：
文献类型：
--
作者：
Rheims, Sylvain;Fischer, Catherine;Mauguiere, Francois
目的：伽玛刀手术（GKS）在颞叶癫痫（TLE）的适应症仍然是一个争论的问题。在最长随访24个月的研究中报告了阳性或阴性结果。目前还没有公布长期数据。方法：我们收集了15例TLE患者的资料，这些患者接受了GKS，随访时间超过24个月。8例患者采用SEEG评估癫痫区（EZ）的定位和扩展。10例患者在其他5例SEEG中表现为中颞叶颞叶（mTLE）白色，表明EZ延伸到中颞叶结构之外。GKS手术以21.1 +/- 2.6 Gy的剂量靶定EZ。结果：平均随访时间60±22.3个月。最后随访7例（46.7%）患者无致残性癫痫发作。GKS后的最后一次癫痫发作平均延迟19.75±20.62个月。在长期无致残性癫痫发作后，无患者复发。在这一人群中，没有显著的预后预测因子可以个体化。然而，10名mTLE患者中有6名（60%）无癫痫发作，而EZ扩展的5名患者中只有1名（20%）表现出相同的癫痫发作结果。结论：当取得积极的结果时，癫痫复发的风险长期保持较低。在典型的mTLE患者中，长期GKS结果可能与常规手术后观察到的结果接近。相反，对于SEEG结果显示EZ不局限于内侧颞结构的患者，不应建议采用该手术。(C) 2008年Elsevier B.V.出版
Purpose: Indication of gamma-knife surgery (GKS) in temporal lobe epilepsy (TLE) remains a matter of debate. Either positive or negative results have been reported in studies with a maximum follow-up of 24 months. No long-term data have been published yet.Methods: We collected data from 15 TLE patients who underwent GKS and whose follow-up was longer than 24 months. Localisation and extension of the epileptogenic zone (EZ) were assessed by SEEG in eight patients. Ten patients were presenting with mesial TLE (mTLE) white in the other five SEEG showed that the EZ was extending beyond mesio-temporal structures. GKS procedure was targeted to the EZ at a dose of 21.1 +/- 2.6 Gy at the margin.Results: The mean duration of the follow-up was 60 +/- 22.3 months. At last follow-up, seven patients (46.7%) were free of disabling seizure. The last seizure following GKS occurred on average after a delay of 19.75 +/- 20.62 months. No patient suffered recurrent seizures after a long period free of disabling seizures. No significant prognostic predictor could be individualized in this population. However, 6 of the 10 patients with mTLE (60%) were seizure free whereas only 1 of the 5 (20%) whose EZ was more extended exhibited the same seizure outcome.Conclusion: When a positive outcome is achieved, the risk of seizure recurrence remains low at long term. In patients with typical mTLE, tong-term GKS results may be closed to those observed after conventional surgery. Conversely, this procedure should not be proposed to patients in whom SEEG results suggest that the EZ is not restricted to mesial temporal structures. (C) 2008 Published by Elsevier B.V.