Efficacy of Frameless Radiosurgical Entorhino-Amygdalohippocampectomy for Pharmacoresistant Medial Temporal Lobe Epilepsy
Abstract
PURPOSE/OBJECTIVE(S)
Evaluate the efficacy and safety of Linac based surgery in the treatment of pharmaco-resistant epilepsies of mesial temporal lobe origin due to medial temporal sclerosis.
MATERIALS/METHODS
Retrospective single institution study comprised of 12 MTLE pts. (10 pts. with MT Sclerosis on Dominant side) who underwent SRS between August 2015 to Jan 2019. The epileptogenic substrate was localized using invasive video-EEG monitoring with foramen ovale electrodes, magnetic resonance imaging, metabolic (PET) imaging. All patients underwent detailed neuropsychological testing and the ESI-55 quality-of-life questionnaire. The radiosurgical target included Anterior part of parahippocampal region; entorhinal area adjacent to the collateral sulcus & rhinal sulcus; hippocampus - head & Anterior part and Amygdalofugal part of the amygdaloid complex. Non-coplanar Volumetrically modulated plans or non-isocentric CK plans using variable collimator were generated for prescribed mean dose of 22gy (range: 20-24 Gy), without any dose heterogeneity. Normal structures doses were within acceptable limits. Radiosurgical treatment was performed by using the C-Arm Linac with hexapod robotics (9 pts.) or frameless robotic radiosurgery system with skull tracking (3pts.). A minimum 2-year follow-up period included clinical, neuropsychological, ophthalmic (Visual field charting) & radiologic evaluations.
RESULTS
Median age at diagnosis is 28 yrs (Range: 17-42yrs). At each 6-month…
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