TREATMENT MODALITY FOR INTRACTABLE EPILEPSY IN HYPOTHALAMIC HAMARTOMATOUS LESIONS

Neurosurgery ◽  
2008 ◽  
Vol 62 (4) ◽  
pp. 847-856 ◽  
Author(s):  
Kyu-Won Shim ◽  
Jong-Hee Chang ◽  
Yong-Gou Park ◽  
Heung-Dong Kim ◽  
Joong-Uhn Choi ◽  
...  
Keyword(s):  
Gamma Knife ◽  
Treatment Modality ◽  
Gamma Knife Radiosurgery ◽  
Intractable Epilepsy ◽  
Severe Case ◽  
Epileptic Focus ◽  
Epilepsy Syndrome ◽  
Seizure Outcome ◽  
Clinical Presentations ◽  
Electroencephalographic Recording

Abstract OBJECTIVE Hypothalamic hamartomas (HHs) are often associated with early-onset gelastic seizures, thus configuring a well recognized and usually severe case of childhood epilepsy syndrome. We present a treatment modality for intractable epilepsy in hypothalamic hamartomatous lesions. METHODS This study presents 14 patients with medically refractory seizure associated with HHs treated between 1995 and 2005. The HHs were diagnosed on the basis of magnetic resonance imaging, except in the case of one patient in whom hamartoma was confirmed histologically. There were seven boys and seven girls in this study. The most frequent clinical presentations were seizures. To identify the epileptic focus, we performed comprehensive epilepsy investigations, including electroencephalographic recording using a depth electrode into the hamartoma. RESULTS To control the seizure, we performed surgical resection in one patient, gamma knife radiosurgery in four patients, and endoscopic disconnection in 11 patients. Seizure outcome was scored according to Engel's classification throughout a mean follow-up period of 27.4 months (range, 3–54 mo). Of the 11 patients who underwent endoscopic disconnection, six were seizure-free immediately after surgery. Two patients were already diagnosed as having an HH and underwent gamma knife radiosurgery, but seizure control was not achieved. Their gelastic seizure disappeared after endoscopic disconnection. CONCLUSION We confirmed that HHs are intrinsically epileptogenic. Therefore, we suggest that HH-related seizures may be controlled by blocking the seizure propagation from epileptogenic HHs through simple disconnection, regardless of the treatment modality, and the endoscopic disconnection of HHs is safer and more effective than other modalities.

Seizure outcome and complications following hypothalamic hamartoma treatment in adults: endoscopic, open, and Gamma Knife procedures

2012 ◽  
Vol 117 (2) ◽  
pp. 255-261 ◽  
Author(s):  
Cornelia Drees ◽  
Kevin Chapman ◽  
Erin Prenger ◽  
Leslie Baxter ◽  
Rama Maganti ◽  
...  
Keyword(s):  
Mental Retardation ◽  
Weight Gain ◽  
Gamma Knife ◽  
Third Ventricle ◽  
Intractable Epilepsy ◽  
Adult Patients ◽  
Neurological Deficits ◽  
Hypothalamic Hamartoma ◽  
Seizure Outcome ◽  
Seizure Freedom

Object This study aimed at identifying outcomes with respect to seizures, morbidity, and mortality in adult patients undergoing resective or Gamma Knife surgery (GKS) to treat intractable epilepsy associated with hypothalamic hamartoma (HH). Methods Adult patients undergoing surgical treatment for HH-related epilepsy were prospectively monitored at a single center for complications and seizure outcome by using a proprietary database. Preintervention and postintervention data for patients 18 years of age and older, and with at least 1 year of follow-up, were analyzed, with specific attention to seizure control, complications, hormonal status, and death. Results Forty adult patients were found in the database (21 were women). The median HH volume was 0.54 cm3. In 70% of patients, it was located inside the third ventricle, attached unilaterally and vertically to the hypothalamus (Delalande Type II). Most patients (26) underwent an endoscopic resection, 10 patients had a transcallosal or other type of open (pterional or orbitozygomatic) resection, and 4 patients chose GKS. Twenty-nine percent became seizure free in the long term, and overall a majority of patients (55%) reported at least > 90% seizure improvement. Only 3 patients were ultimately able to discontinue anticonvulsants, whereas most patients were taking an average of 2 antiepileptic drugs pre- and postoperatively. The only factor significantly correlated with seizure-free outcome was the absence of mental retardation. The HH volume, HH type, and amount of resection or disconnection were not correlated to seizure freedom. A total of 4 patients (10%) died, 2 immediately after surgery and 2 later. All of them had undergone a resection, as opposed to GKS, and still had seizures. Postoperatively, persistent neurological deficits were seen in 1 patient; 34% of patients had mild hormonal problems; and 59% experienced weight gain of at least 6.8 kg (average gain 12.7 kg). Conclusions Surgical or GKS procedures in adults with HH provided seizure freedom in one-third of patients. The only significant favorable prognostic factor was the absence of mental retardation. The overall mortality rate was high, at 10%. Other important morbidities were persistent hormonal disturbances and weight gain.

Gamma Knife radiosurgery as a treatment modality for low-grade pediatric brainstem gliomas: report of two cases

2011 ◽  
Vol 28 (1) ◽  
pp. 175-178 ◽  
Author(s):  
Chih-Hsiang Liao ◽  
David Hung-Chi Pan ◽  
Huai-Che Yang ◽  
Hsiu-Mei Wu ◽  
Donald Ming-Tak Ho ◽  
...  
Keyword(s):  
Gamma Knife ◽  
Treatment Modality ◽  
Gamma Knife Radiosurgery ◽  
Low Grade ◽  
Pediatric Brainstem Gliomas

scholarly journals Efficacy of Gamma Knife Radiosurgery in Refractory Obsessive-Compulsive Disorder: An Indian Experience

2022 ◽  
Author(s):  
Sanjeev Pattankar ◽  
Milind Sankhe ◽  
Kersi Chavda
Keyword(s):  
Obsessive Compulsive Disorder ◽  
Gamma Knife ◽  
Treatment Modality ◽  
Gamma Knife Radiosurgery ◽  
Obsessive Compulsive ◽  
Noninvasive Treatment ◽  
Long Term Outcome ◽  
Compulsive Disorder ◽  
Anterior Capsulotomy

Abstract Background Obsessive-compulsive disorder (OCD) is a chronic debilitating psychiatric condition with adverse impact on patient's sociooccupational health. Refractoriness to pharmacotherapy and psychotherapy is not uncommon. Gamma Knife radiosurgery (GKRS) is the comprehensively used and reviewed treatment modality in refractory OCD worldwide. In India, the past two decades of increasing GKRS availability has failed to create the necessary local awareness of its usefulness in refractory OCD. Limited native literature deepens the problem. Objective To analyze our experience with GKRS in refractory OCD, and report the safety and efficacy/long-term outcome in patients using the Yale–Brown Obsessive-Compulsive Scale (Y-BOCS). Materials and Methods A retrospective review of patients receiving GKRS for refractory OCD between 2000 and 2020 was carried out. Case files of the eligible (n = 9) patients were reviewed for clinical, radiotherapeutic, and outcome data. Additionally, patients were contacted via telephone to enquire about their experiences, and to obtain retroactive consent for GKRS in June 2021. Information obtained was collated, computed, and analyzed. Results Male-to-female sex ratio was 8:1. Mean age at the time of GKRS and mean duration of OCD prior to GKRS was 30.1 ± 9.4 and 10.2 ± 5.8 years, respectively. Mean baseline Y-BOCS score was 29.6 ± 4.7. Our first patient received cingulotomy, while the rest underwent anterior capsulotomy. Median margin dose (50% isodose) was 70 Gy. Also, 23.8 ± 7.7 was the mean Y-BOCS score at the last follow-up (median = 30 months). Overall, 44.4% patients showed full/partial response (≥25% reduction in Y-BOCS score) at the last follow-up. In anterior capsulotomy (eight patients), patients with moderate/severe OCD showed better response (4/5 responders) than those with extreme OCD (0/3 responders). Single case of cingulotomy resulted in no response (<25% reduction in Y-BOCS score). No adverse radiation effects were noted. Also, 55.6% patients gave retroactive consent telephonically. Conclusion GKRS is a safe and effective noninvasive treatment modality for refractory OCD. Ventral anterior capsule is the preferred target. Maximum radiation doses of 120 to 160 Gy are well tolerated. Extremely severe OCD cases fared poorer. Proper awareness about the availability and efficacy of GKRS in refractory OCD is required in India.

Gamma-knife radiosurgery as an optimal treatment modality for brain metastases from epithelial ovarian cancer

2008 ◽  
Vol 108 (3) ◽  
pp. 505-509 ◽  
Author(s):  
Yoo-Kyung Lee ◽  
Noh-Hyun Park ◽  
Jae Weon Kim ◽  
Yong-Sang Song ◽  
Soon-Beom Kang ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Brain Metastases ◽  
Epithelial Ovarian Cancer ◽  
Gamma Knife ◽  
Treatment Modality ◽  
Gamma Knife Radiosurgery ◽  
Optimal Treatment

Long-Term Outcomes After Gamma Knife Radiosurgery for Benign Meningioma: A Single Institution's Experience With 424 Patients

Neurosurgery ◽  
2018 ◽  
Vol 83 (5) ◽  
pp. 1040-1049 ◽  
Author(s):  
Youngbeom Seo ◽  
Dong Gyu Kim ◽  
Jin Wook Kim ◽  
Jung Ho Han ◽  
Hyun-Tai Chung ◽  
...  
Keyword(s):  
Tumor Progression ◽  
Gamma Knife ◽  
Treatment Modality ◽  
Gamma Knife Radiosurgery ◽  
Hazard Ratio ◽  
Tumor Control ◽  
Long Term Outcomes ◽  
Tumor Control Rate

Abstract BACKGROUND Gamma knife radiosurgery (GKRS) is recognized as an important treatment modality for meningioma. OBJECTIVE To analyze the long-term outcomes in meningioma patients treated with GKRS to determine the risk factors related to treatment failure and peritumoral edema (PTE) development. METHODS Between 1998 and 2010, 770 consecutive patients were treated with GKRS for intracranial meningioma. After the exclusion of patients with follow-up periods of less than 5 yr and those with neurofibromatosis, multiple meningiomas, nonbenign meningioma, or radiotherapy, a total of 424 patients were enrolled in this study. The median follow-up duration was 92 mo. The median tumor volume was 4.35 cm3, and the median marginal dose was 14 Gy. RESULTS The overall local tumor control rate was 84%. The actuarial tumor control rates were 91.7% and 78.9% at 5 and 10 yr, respectively. The tumor control rate of a radiologically diagnosed tumor was higher than that of a grade I tumor (82% vs 70.1% at 10 yr, P = .001). In multivariate analysis, factors associated with tumor progression were female sex (hazard ratio: 0.5, P = .025) and a previous history of craniotomy (hazard ratio: 1.9, P = .009). Symptomatic PTE was identified in 36 (8.5%) patients, and the factor associated with poor PTE was the presence of PTE before GKRS (odds ratio: 4.6, P &lt; .001). Permanent complication rate was 4%. CONCLUSION GKRS appears to be an effective treatment modality for meningioma with long-term follow-up. However, the identification of delayed tumor progression in our study suggests that extended follow-up data should be collected after GKRS.

Seizure Outcome in Children Treated for Arteriovenous Malformations Using Gamma Knife Radiosurgery

1996 ◽  
Vol 24 (3) ◽  
pp. 139-144 ◽  
Author(s):  
Peter C. Gerszten ◽  
David Adelson ◽  
Douglas Kondziolka ◽  
John C. Flickinger ◽  
Dade Lunsford
Keyword(s):  
Gamma Knife ◽  
Arteriovenous Malformations ◽  
Gamma Knife Radiosurgery ◽  
Seizure Outcome

Surgical outcome for focal cortical dysplasia: an analysis of recent surgical series

2010 ◽  
Vol 6 (5) ◽  
pp. 452-458 ◽  
Author(s):  
Joshua J. Chern ◽  
Akash J. Patel ◽  
Andrew Jea ◽  
Daniel J. Curry ◽  
Youssef G. Comair
Keyword(s):  
Functional Imaging ◽  
Surgical Outcome ◽  
Focal Cortical Dysplasia ◽  
Intractable Epilepsy ◽  
Cortical Dysplasia ◽  
Prognostic Indicators ◽  
Seizure Outcome ◽  
Clinical Presentations ◽  
Number Of Patients ◽  
Selection For

Object Focal cortical dysplasia (FCD) is an important cause of intractable epilepsy and is at times treatable by resection. The now widespread use of MR imaging and recent advancement of functional imaging have increased the number of patients undergoing surgical treatment for FCD. The objective of this review is to critically examine and to provide a summary of surgical series on FCD published since 2000. Methods Studies concerning surgery for FCD were identified from MEDLINE and references of selected articles and book chapters. Data from these included studies were summarized and analyzed to identify factors correlated with seizure outcome. Results Sixteen studies were identified, and 469 patients met our selection criteria. Seizure-free outcome at 1-year postoperatively was achieved in 59.7% of the patients. Children and adults were equally likely to benefit from the surgery. Complete resection (OR 13.7, 95% CI 6.68–28.1; p < 0.0001) and temporal location (OR 2.15, 95% CI 1.26–3.69; p = 0.0073) were two positive prognostic indicators of seizure-free outcome. Utilization of invasive monitoring did not affect the chance of seizure remission, but firm conclusions could not be drawn because patients were not randomized. Conclusions The advancement of modern imaging has transformed the process of surgical candidate selection for partial epilepsy due to FCD. Patients from recent surgical series were more homogeneous in their clinical presentations and might represent FCD as an independent pathological entity. This likely explained the improved surgical outcome for this group of patients. These reports also documented the increased utilization of functional imaging, but their efficacy needs to be verified with further studies.

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