Gamma Knife surgery, a neuromodulation therapy in epilepsy surgery!

Area of Science:

• Neurosurgery
• Radiation Oncology
• Epileptology

Background:

• Classical epilepsy surgery involves removing the epileptogenic zone (EZ).
• A critical review explores radiosurgery's potential non-destructive effects in epilepsy treatment.
• This approach is particularly relevant for epilepsy cases involving lesions in highly functional brain areas.

Purpose of the Study:

• To review evidence supporting radiosurgery as a non-destructive epilepsy treatment.
• To evaluate the efficacy and safety of radiosurgery for epilepsy originating from specific lesions.
• To explore the potential of radiosurgery to induce neural plasticity without causing necrosis.

Main Methods:

• Review of clinical cases of epilepsy patients treated with radiosurgery.
• Analysis of experimental studies investigating radiosurgery's biochemical and cellular effects.
• Focus on radiosurgery applied directly to the epileptogenic zone (EZ).

Main Results:

• Clinical data show seizure relief and no functional worsening in patients treated with radiosurgery.
• Experimental studies indicate radiosurgery can induce biochemical changes, glial cell elimination, and stem cell migration.
• Non-necrotizing radiosurgery doses appear to induce plasticity phenomena.

Conclusions:

• Gamma Knife radiosurgery demonstrates capability to modulate the neural system.
• The precise mechanisms and optimal dosimetry for inducing plasticity without necrosis require further investigation.
• Radiosurgery presents a rationale for treating the EZ cortex, preserving function when surgical resection poses high risks.