Artikel
Interstitial stereotactic radiosurgery for lesional epilepsy
Interstitielle Radiochirurgie in der Behandlung läsionaler Epilepsien
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Autoren
Veröffentlicht: | 23. April 2004 |
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Gliederung
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Objective
Small circumscribed low-grade gliomas mainly present with intractable epilepsy. Interstitial stereotactic radiosurgery as an alternative to surgery has been effective for temporal lesional epilepsy. We performed a study on extra temporal lesional epilepsy using interstitial radiosurgery.
Methods
23 patients with histologically proven low-grade gliomas have been studied with a median follow-up of 16.2 months after Iodine-125 interstitial radiosurgery. Maximum tumour diameter was 3.5cm. All patients were treated with 60Gy to the tumour margin. Dose rate was 10cGy per hour. Follow-up was done clinically with MRs and a comparison of pre-radiosurgery to post-radiosurgery Proton-MR spectroscopy every 6 months.
Results
Out of 23 patients, 19 have become seizure free (Engel class I) 3 patients had a significant, more than 75% reduction of seizure frequency (Engel class II) and 1 patient had no change. According to the MacDonald classification 4 patients had a complete response. 17 patients had a partial response. 2 patients had stable disease. All patients with a complete response had Engel class I outcome and the other 15 patients with Engel class I outcome had partial responses. The choline/creatinine ratio of tumours dropped from a median of 1.62 ± .4 before radiosurgery to 1.02 ± .31 after radiosurgery (3 month follow-up) in patients with Engel class I with no change (1.38 ± .4) in the rest.
Conclusions
Interstitial stereotactic radiosurgery in small circumscribed low-grade gliomas is not only an efficient tumour treatment but highly effective for the treatment of concomitant epilepsy. Furthermore MR spectroscopy might allow to predict seizure outcome early after interstitial radiosurgery using the choline/creatinine equation.