What role for radiosurgery in mesial temporal lobe epilepsy

The Gamma Knife radiosurgery is a neurosurgical approach having now demonstrated well its efficiency, its low morbidity and its comfort in the treatment of numerous neurosurgical disorders. These advantages of this type of intervention make it a method of great interest in functional neurosurgery and quite particularly in surgery of epilepsy. French experience is a pioneer one in this domain. Since for several years the positive evolution of the epilepsy associated with brain lesions had been noticed after radiosurgical Gamma Knife treatment, the use of this approach in surgery of epilepsy has been systematically evaluated since 1993. Data are today available concerning the surgical treatment of the epilepsies originating in the temporomesial area without space-occupying process, epilepsies associated to hypothalamic hamartomas and epilepsies associated with cavernous angiomas or low grade gliomas. The quality of the epileptological result obtained in these various indications associated with a very reduced morbidity lets assume that the Gamma Knife radiosurgery could indeed have tomorrow a place within the sample group of surgical approaches dedicated to the treatment of severe epilepsies. However, a larger number of treated patients and a more prolonged follow-up remains necessary to assess this approach in a more definitive way.