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Radiosurgical treatment for epilepsy associated with cavernomas
Marc Lévêque1, Romain Carron, Fabrice Bartolomei
1Service de Neurochirurgie Fonctionnelle et Stéréotaxique, Assistance Publique des Hôpitaux de Marseille, Marseille, France.
Progress in Neurological Surgery
|December 22, 2012
Summary
Gamma Knife radiosurgery effectively manages drug-resistant epilepsy in patients with cavernous malformations (CMs). Over half of patients became seizure-free, with significant improvement in many others, demonstrating radiosurgery
Area of Science:
- Neurology
- Neurosurgery
- Radiation Oncology
Background:
- Cavernous malformations (CMs) are congenital brain vascular anomalies.
- Drug-resistant epilepsy is a common, debilitating complication of CMs.
- Microsurgical excision is standard for non-eloquent CMs; radiosurgery is an alternative for eloquent lesions.
Purpose of the Study:
- To evaluate the effectiveness and safety of Gamma Knife (GK) radiosurgery for drug-resistant epilepsy caused by CMs.
- To assess seizure control rates and identify factors influencing outcomes.
Main Methods:
- Retrospective multicenter study of 49 patients with CMs and drug-resistant epilepsy.
- Patients underwent GK radiosurgery with a mean marginal dose of 19.17 Gy.
- Epilepsy duration averaged 7.5 years, with a mean seizure frequency of 6.9/month pre-treatment.
Main Results:
- 53% of patients achieved complete seizure freedom post-GK radiosurgery.
- An additional 20% experienced a significant reduction in seizure frequency.
- Low morbidity was observed, and 26% showed minimal or no improvement.
Conclusions:
- Gamma Knife radiosurgery is a promising treatment for epilepsy associated with CMs, particularly in eloquent locations.
- Accurate delineation of the epileptogenic zone and optimal radiation dosing are crucial for successful outcomes.
- Further prospective studies are needed to validate these findings.
