Gamma knife callosotomy in children with drug-resistant epilepsyYoshiyasu Iwai1, Kazuhiro Yamanaka2, Ichiro Kuki3, Shin Okazaki3, Hisashi Kawawaki31Osaka, Japan 2Department of Neurosurgery, Osaka City General Hospital 3Department of Pediatric Neurology, Osaka City General Hospital Keywords: epilepsy, radiosurgery, gamma knife, callosotomy, seizuresInteractive ManuscriptAsk Questions of this Manuscript: What is the background behind your study?Corpus callostomy can be an effective procedure for selected epilepsy patients. What is the purpose of your study?We evaluated the efficacy of gamma knife callosotomy. Describe your patient group.Case 1: a 14-year-old female had a history of complex-partial seizure and drop attack from the age of 2 and half years. At the age of 9-years, the patient suffered behavior disturbance. At 14-years old the patient received gamma knife radiosurgery (GKS) for the anterior half of the corpus callosum with a maximum dose of 140 Gy (4 mm collimator,9shots, treatment volume 0.98ml). Case 2: a 5-year-old male. The patient suffered complex seizure from the age of 4 months, and with west syndrome at the age of 5 months. He also suffered drop attack from 3 years old. GKS was performed on the anterior one third of the corpus callosum with a maximum dose of 140 Gy (4mm collimator, 11 shots, treatment volume 1.15ml). Describe what you did.We performed gamma knife callosotomy for two patients with intractable epilepsy associated with tuber sclerosis. Describe your main findings.Case 1: After the procedure, drop attacks decreased 25%, urinary incontinence disappeared, and behavior disturbance was improved. 8 to 14 months after GKS, brain edema occurred without symptoms. The patient received a second GKS for the posterior third of the corpus callosum with a maximum dose of 140 Gy (4 mm collimator, 8 shots, treatment volume 0.63ml) 23 months after the first GKS. 1 month after the second GKS, complex-partial seizure was markedly improved and 5 months after, the seizures had almost disappeared.
Case 2: This patient showed no improvement with brain edema at the frontal lobe between 6 to 9 months after GKS. The patient received a second GKS for the posterior one third of the corpus callosum with a maximum dose of 140 Gy (4 mm collimator, 7 shots, treatment volume 0.59 ml) 19 months after the first GKS. Describe the main limitation of this study.This was a small retrospective series. Describe your main conclusion.Our experiences revealed that the gamma knife callosotomy can be effective for intractable seizure in some patients, but we need further evaluation and long-term follow-up of outcome and complications. Describe the importance of your findings and how they can be used by others.Additional research is necessary to determine the value of radiosurgical callosotomy. Corpus callostomy can be an effective procedure for selected epilepsy patients. We evaluated the efficacy of gamma knife callosotomy. Case 1: a 14-year-old female had a history of complex-partial seizure and drop attack from the age of 2 and half years. At the age of 9-years, the patient suffered behavior disturbance. At 14-years old the patient received gamma knife radiosurgery (GKS) for the anterior half of the corpus callosum with a maximum dose of 140 Gy (4 mm collimator,9shots, treatment volume 0.98ml). Case 2: a 5-year-old male. The patient suffered complex seizure from the age of 4 months, and with west syndrome at the age of 5 months. He also suffered drop attack from 3 years old. GKS was performed on the anterior one third of the corpus callosum with a maximum dose of 140 Gy (4mm collimator, 11 shots, treatment volume 1.15ml). We performed gamma knife callosotomy for two patients with intractable epilepsy associated with tuber sclerosis. Case 1: After the procedure, drop attacks decreased 25%, urinary incontinence disappeared, and behavior disturbance was improved. 8 to 14 months after GKS, brain edema occurred without symptoms. The patient received a second GKS for the posterior third of the corpus callosum with a maximum dose of 140 Gy (4 mm collimator, 8 shots, treatment volume 0.63ml) 23 months after the first GKS. 1 month after the second GKS, complex-partial seizure was markedly improved and 5 months after, the seizures had almost disappeared.
Case 2: This patient showed no improvement with brain edema at the frontal lobe between 6 to 9 months after GKS. The patient received a second GKS for the posterior one third of the corpus callosum with a maximum dose of 140 Gy (4 mm collimator, 7 shots, treatment volume 0.59 ml) 19 months after the first GKS. This was a small retrospective series. Our experiences revealed that the gamma knife callosotomy can be effective for intractable seizure in some patients, but we need further evaluation and long-term follow-up of outcome and complications. Additional research is necessary to determine the value of radiosurgical callosotomy. Project Roles:
Y. Iwai (), K. Yamanaka (), I. Kuki (), S. Okazaki (), H. Kawawaki ()
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