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首页> 外文期刊>Epilepsy & Behavior Case Reports >Radiosurgery for the treatment of dominant hemisphere periventricular heterotopia and intractable epilepsy in a series of three patients
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Radiosurgery for the treatment of dominant hemisphere periventricular heterotopia and intractable epilepsy in a series of three patients

机译：放射外科治疗三名患者的优势半球室周异位症和顽固性癫痫

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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 37.5–65Gy resulted in seizure freedom for at least 14months 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.
机译：脑室周围异位症（PVH）是一种神经元迁移疾病，其特征是沿侧脑室定位的灰质块通常引起癫痫。迄今为止，在病例报告中已证明了手术切除PVH的益处;然而，PVH在侧脑室的三角旁区域的位置可能会带来重大的手术挑战。因此，必须考虑消融这种致癫痫病灶的非侵入性方式。我们介绍了三例因无法手术的单侧优势半球PVH接受立体定向放射外科手术（SRS）的患者，以说明这种治疗方式的潜在益处和风险。在最后一次随访时，总剂量为37.5–65Gy的患者可导致癫痫发作至少持续14个月，即使患者患有第二个独立的癫痫病重点。因此不确定颅内电极记录是否真正提供了附加价值。两名接受较高放射剂量的患者出现症状性放射坏死和相关的脑水肿，需要进一步的医疗干预，并且一名患者持续出现单眼视力丧失。尽管可以尝试更长的时间间隔再治疗，但没有患者表现出通常与癫痫发作缓解相关的影像学发现。 PVH引起的难治性癫痫可以通过放射疗法成功治疗;但是还需要进一步的工作来定义最佳剂量参数，以降低对正常组织的毒性。

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