Epilepsy Surgery versus Gamma Knife Radiosurgery in Management of Mesial Temporal Lobe Epilepsy with Hippocampal Sclerosis.

Abstract

Abstract: Mesial temporal lobe epilepsy is the most common form of human epilepsy, and its pathophysiological substrate is usually hippocampal sclerosis (Ammon’s horn sclerosis). The disabling seizures associated with mesial temporal lobe epilepsy are typically resistant to antiepileptic drugs but can be abolished in most patients by surgical treatment. MTLE with HS is the most common drug-resistant disorder observed in epilepsy surgery programs. Although being the gold standard treatment for MTLE with HS, ATL remains markedly underutilized. The reasons behind underutilization are multifactorial. One reason is the perceived risks and the fears about open brain surgery. That’s why new surgical modalities have been recently developed to provide less invasive alternatives for this surgically remediable disorder. Among these alternatives is gammaknife radiosurgery (GKR) that implies delivery of radioactive cobalt beams to the temporal mesial structures (amygdale, hippocampus and parahippocampal gyrus). The results of GKR were found to be comparable to ATL as regard seizure freedom especially with using high dose therapy (24 Gy). The major advantage of radiosurgery in comparison with open surgery is its minimally invasive nature. Another advantage of radiosurgery is the possibility of better neuropsychological outcomes. In this review, we searched the literature and summarized the available knowledge from literature on the long term efficacy and safety of gamma knife radiosurgery in comparison to temporal lobe epilepsy surgery in achieving seizure control and improving the neuropsychological outcomes in patients with mesial temporal lobe epilepsy with hippocampal sclerosis.