Radiosurgery versus open surgery for mesial temporal lobe epilepsy: The randomized, controlled ROSE trial

Area of Science:

• Neurosurgery
• Epilepsy Treatment
• Radiosurgery

Background:

• Pharmacoresistant unilateral mesial temporal lobe epilepsy (MTLE) poses a significant treatment challenge.
• Anterior temporal lobectomy (ATL) is a standard surgical option, while stereotactic radiosurgery (SRS) offers a less invasive alternative.
• Direct comparative data on the efficacy and safety of SRS versus ATL for MTLE are limited.

Purpose of the Study:

• To compare the effectiveness and safety of stereotactic radiosurgery (SRS) against anterior temporal lobectomy (ATL).
• To evaluate seizure remission, verbal memory, and quality of life outcomes at 36 months post-treatment for pharmacoresistant unilateral MTLE.

Main Methods:

• A randomized, single-blinded, controlled trial involving 58 adult patients across 14 centers in the USA, UK, and India.
• Patients were randomized to receive either SRS (24 Gy) or standardized ATL.
• Outcomes assessed included seizure remission, verbal memory changes, quality of life, and adverse events at 36-month follow-up.

Main Results:

• Higher seizure remission rates were observed in the ATL group (78%) compared to the SRS group (52%).
• No significant difference in verbal memory changes was found between the two treatment arms.
• Quality of life improved with seizure remission; adverse events were consistent with known profiles for each procedure.

Conclusions:

• Anterior temporal lobectomy (ATL) demonstrates a superior proportion of seizure remission compared to stereotactic radiosurgery (SRS) for MTLE.
• Both SRS and ATL are effective and possess reasonable safety profiles for treating MTLE.
• SRS serves as a viable alternative for patients who are not candidates for, or are hesitant to undergo, open surgery like ATL.