Limits...
Radiosurgery for the treatment of dominant hemisphere periventricular heterotopia and intractable epilepsy in a series of three patients.

Wu C, Sperling MR, Falowski SM, Chitale AV, Werner-Wasik M, Evans JJ, Andrews DW, Sharan AD - Epilepsy Behav Case Rep (2012)

Bottom Line: The benefit of surgical resection of the PVH has been demonstrated in case reports to date; however, the location of the PVH in the paratrigonal region of the lateral ventricles can present significant surgical challenges.While a longer interval prior to re-treatment may have been attempted, neither patient demonstrated radiographic findings typically associated with seizure remission.Refractory epilepsy due to PVH may be successfully treated with radiation therapy; but further work is needed to define the optimal dosing parameters in order to lower toxicity to normal tissue.

View Article: PubMed Central - PubMed

Affiliation: Thomas Jefferson University Hospitals, Department of Neurological Surgery, 909 Walnut Street, Third Floor, Philadelphia, PA, USA.

ABSTRACT
Periventricular heterotopia (PVH) is a neuronal migration disorder characterized by masses of gray matter located along the lateral ventricles that commonly cause epilepsy. The benefit of surgical resection of the PVH has been demonstrated in case reports to date; however, the location of the PVH in the paratrigonal region of the lateral ventricles can present significant surgical challenges. Noninvasive modalities of ablating this epileptogenic focus must therefore be considered. We present a small series of three patients who underwent stereotactic radiosurgery (SRS) for inoperable unilateral dominant hemisphere PVHs in order to illustrate the potential benefits and risks of this treatment modality. A total dose of 37.5-65 Gy resulted in seizure freedom for at least 14 months at the time of their last follow-up, even in patients harboring a second independent epileptic focus. Whether intracranial electrode recording truly offers added value is therefore uncertain. The two patients who received higher radiation doses suffered from symptomatic radiation necrosis and associated cerebral edema, requiring further medical intervention, and persistent monocular visual loss in one patient. While a longer interval prior to re-treatment may have been attempted, neither patient demonstrated radiographic findings typically associated with seizure remission. Refractory epilepsy due to PVH may be successfully treated with radiation therapy; but further work is needed to define the optimal dosing parameters in order to lower toxicity to normal tissue.

No MeSH data available.


Related in: MedlinePlus

A: Post-operative coronal T1 MRI showing depth electrodes.B: Dose plan for Case 3.C: Axial FLAIR MRI at 19 months post-treatment showing radiation necrosis.
© Copyright Policy
Related In: Results  -  Collection


getmorefigures.php?uid=PMC4150677&req=5

f0015: A: Post-operative coronal T1 MRI showing depth electrodes.B: Dose plan for Case 3.C: Axial FLAIR MRI at 19 months post-treatment showing radiation necrosis.

Mentions: Scalp video-EEG demonstrated frequent interictal left temporal lobe slowing and sharp waves. Complex partial seizures began with 8-Hz activity originating at T5. Imaging studies included an MRI consistent with PVH involving the left lateral ventricle in the trigone and region of the occipital horn (Fig. 3A).


Radiosurgery for the treatment of dominant hemisphere periventricular heterotopia and intractable epilepsy in a series of three patients.

Wu C, Sperling MR, Falowski SM, Chitale AV, Werner-Wasik M, Evans JJ, Andrews DW, Sharan AD - Epilepsy Behav Case Rep (2012)

A: Post-operative coronal T1 MRI showing depth electrodes.B: Dose plan for Case 3.C: Axial FLAIR MRI at 19 months post-treatment showing radiation necrosis.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4150677&req=5

f0015: A: Post-operative coronal T1 MRI showing depth electrodes.B: Dose plan for Case 3.C: Axial FLAIR MRI at 19 months post-treatment showing radiation necrosis.
Mentions: Scalp video-EEG demonstrated frequent interictal left temporal lobe slowing and sharp waves. Complex partial seizures began with 8-Hz activity originating at T5. Imaging studies included an MRI consistent with PVH involving the left lateral ventricle in the trigone and region of the occipital horn (Fig. 3A).

Bottom Line: The benefit of surgical resection of the PVH has been demonstrated in case reports to date; however, the location of the PVH in the paratrigonal region of the lateral ventricles can present significant surgical challenges.While a longer interval prior to re-treatment may have been attempted, neither patient demonstrated radiographic findings typically associated with seizure remission.Refractory epilepsy due to PVH may be successfully treated with radiation therapy; but further work is needed to define the optimal dosing parameters in order to lower toxicity to normal tissue.

View Article: PubMed Central - PubMed

Affiliation: Thomas Jefferson University Hospitals, Department of Neurological Surgery, 909 Walnut Street, Third Floor, Philadelphia, PA, USA.

ABSTRACT
Periventricular heterotopia (PVH) is a neuronal migration disorder characterized by masses of gray matter located along the lateral ventricles that commonly cause epilepsy. The benefit of surgical resection of the PVH has been demonstrated in case reports to date; however, the location of the PVH in the paratrigonal region of the lateral ventricles can present significant surgical challenges. Noninvasive modalities of ablating this epileptogenic focus must therefore be considered. We present a small series of three patients who underwent stereotactic radiosurgery (SRS) for inoperable unilateral dominant hemisphere PVHs in order to illustrate the potential benefits and risks of this treatment modality. A total dose of 37.5-65 Gy resulted in seizure freedom for at least 14 months at the time of their last follow-up, even in patients harboring a second independent epileptic focus. Whether intracranial electrode recording truly offers added value is therefore uncertain. The two patients who received higher radiation doses suffered from symptomatic radiation necrosis and associated cerebral edema, requiring further medical intervention, and persistent monocular visual loss in one patient. While a longer interval prior to re-treatment may have been attempted, neither patient demonstrated radiographic findings typically associated with seizure remission. Refractory epilepsy due to PVH may be successfully treated with radiation therapy; but further work is needed to define the optimal dosing parameters in order to lower toxicity to normal tissue.

No MeSH data available.


Related in: MedlinePlus