Gamma Knife Radiosurgery For Drug Resistant Mesial Temporal Epilepsy: Experience In Han Subjects Of Southwestern China

Heng Wan1, Ohye Chihiro2, Davin Cuker3, Shubin Yuan4, Wei Wang5

1Chengdu, China 2 Hidaka Hospital 3Harvard Medical School 4 Chengdu Air-force 52 Hospital 5 West China hospital

Keywords: gamma knife, mesial temporal sclerosis, epilepsy, outcome, radiosurgery

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     Stereotactic radiosurgery has been reintroduced as an alternative to surgery in drug-resistant epilepsies of mesial temporal lobe origin recently.
     The goal of this research is to define accurately the efficacy, safety, complications, and role of stereotactic radiosurgery for treatment of mesial temporal lobe epilepsy especially in Han subjects, and to evaluate the critical time for judging the outcomes.
     From 2000 to 2003, a total of 241 patients with drug-resistant mesial temporal lobe epilepsy treated with the Leksell Gamma Knife (LGK).
     The preoperative investigations included video-EEG with foramen ovale electrodes, magnetic resonance imaging, and quality-of-life questionnaire. Radiosurgical treatment was performed at a dose of 25 Gy at the margin. The target included the anterior parahippocampal cortex and the basal and lateral part of the amygdala and hippocampus. A minimum 4 years follow-up data were identified. The authors evaluate and view the outcomes following the Engel classification in one year,two year and long-term follow-up.
     In one year follow-up: 62 (25.7?) had Engel I outcome, 87 (36.1?) had Engel II outcome, 55 (22.8?) benefit from the operation, and 37 (15.4?) had unsatisfied outcomes. In two year follow up: 36 (14.9?) had Engel I outcome, 68 (28.2?) had Engel II outcome, 59 (24.5?) benefit from the operation, 78 (32.4?) had unsatisfied outcomes. In long-term follow-up (range 4?7 years): 26 (10.8?) had Engel I outcome, 79 (32.8?) had Engel II outcome, 53 (22.0?) benefit from the operation, and 83 (34.4?) suffered unsatisfied outcomes. The ratio of the Engel III outcomes in one year and two year follow up has statistically obvious difference, but the ratio of the Engel III outcomes in two year and long-term follow up has no statistically significant difference.
     This is a retrospective study.
     LGK for temporal lobe epilepsy is safe and reliable.
     None of the patients in our study suffered death related with LGK. It is unreliable to judge the outcome within one year’s following. The two year following may predict the long-term out comes.


Project Roles:

H. Wan (), O. Chihiro (), D. Cuker (), S. Yuan (), W. Wang ()