Stereotactic radiosurgery for medically refractory non-lesional epilepsy: A case-based Radiosurgery Society (RSS)...

Area of Science:

• Neurosurgery
• Radiation Oncology
• Epileptology

Background:

• Medically refractory epilepsy (MRE) affects approximately 30% of epilepsy patients, necessitating advanced treatment strategies.
• Anterior temporal lobectomy (ATL) is a classic treatment for medial temporal lobe epilepsy (mTLE), but less invasive options like stereotactic radiosurgery (SRS) are gaining prominence.
• SRS presents a non-invasive therapeutic option for MRE, with its application expanding in recent literature.

Purpose of the Study:

• To provide an overview of stereotactic radiosurgery (SRS) for medically refractory epilepsy (MRE).
• To discuss the optimal techniques, advantages, alternatives, and risks associated with SRS in MRE management.
• To illustrate the application of SRS through two distinct patient case studies.

Main Methods:

• Presentation of two case studies involving patients with MRE unsuitable for invasive surgical options.
• Both patients underwent SRS targeting medial temporal lobe structures.
• Case 1: A 65-year-old female with comorbidities and left temporal lobe epilepsy.
• Case 2: A 19-year-old male with Protein C deficiency and medial temporal lobe sclerosis.

Main Results:

• Both patients treated with SRS demonstrated significant reductions in seizure frequency and severity.
• SRS provided a viable treatment alternative for patients with MRE who were poor candidates for traditional surgery.

Conclusions:

• Stereotactic radiosurgery (SRS) is generally less effective than anterior temporal lobectomy (ATL) for seizure reduction in medically refractory mTLE.
• SRS is a suitable consideration for specific patient groups, including those with high surgical risks due to comorbidities, epileptogenic foci in eloquent areas, or those who prefer non-surgical options.
• Patients and clinicians must be aware of SRS risks, including delayed cerebral edema, visual field deficits, and radiation necrosis, necessitating careful patient counseling and monitoring.