caa a22 4500 606215360 CHVBK 20210128101058.0 cr unu---uuuuu 210128e20151001xx s 000 0 eng 10.1007/s00701-015-2525-2 doi (NATIONALLICENCE)springer-10.1007/s00701-015-2525-2 Morphological changes after radiosurgery for mesial temporal lobe epilepsy [Elektronische Daten] [Zdeněk Vojtěch, Hana Malíková, Martin Syrůček, Lenka Krámská, Jan Šroubek, Vilibald Vladyka, Roman Liščák] Background: To review our experience with morphological developments during the long-term follow-up of patients treated by Gamma Knife radiosurgery for mesial temporal lobe epilepsy. Method: Between 1995 and 1999, we treated 14 patients with marginal doses of 24Gy (n = 6) and 18-20Gy (n = 8). Nine of these were operated on for insufficient seizure control. We reviewed seizure outcome and magnetic resonance images in both operated and unoperated patients and also re-examined histopathology specimens. Results: Of the nine operated patients, two were Engel IIIA, one was IVA, five were IVB, and one was Engel IVC prior to surgery. At their final visit, five cases had become Engel class IA, one patient was ID, and two were IIC. In one patient the follow-up was not long enough for classification. Of the five unoperated patients, one was Engel class IB, one was IIIA, one IIB and one IVB at their final visit. Radionecrosis developed in 11 patients, occurring more often and earlier in those treated with higher doses. Collateral edema reached outside the temporal lobe in six patients, caused uncal herniation in two and intracranial hypertension in three. During longer follow-up, postnecrotic pseudocysts developed in 9 patients, and postcontrast enhancement persisted for 2.5-16years after GKRS in all 14 patients. In five of them we detected its progression between 2 and 16years after treatment. Signs of neoangiogenesis were found in two patients and microbleeds could be seen in five. Histopathology revealed blood vessel proliferation and macrophage infiltration. Conclusions: Early delayed complications and morphological signs suggesting a risk of development of late delayed complications are frequent after radiosurgery for mesial temporal lobe epilepsy. Together with its unproven antiseizure efficacy, these issues should be taken into account when planning future studies of this method. The Author(s), 2015 Gamma knife nationallicence Mesial temporal sclerosis nationallicence Epilepsy surgery nationallicence Radionecrosis nationallicence Vojtěch Zdeněk Department of Neurology, Na Homolce Hospital, Roentgenova 2, 15030, Prague 5-Motol, Czech Republic aut Malíková Hana Department of Radiodiagnostics, Na Homolce Hospital, Prague, Czech Republic aut Syrůček Martin Department of Pathology, Na Homolce Hospital, Prague, Czech Republic aut Krámská Lenka Department of Psychology, Na Homolce Hospital, Prague, Czech Republic aut Šroubek Jan Department of Neurosurgery, Na Homolce Hospital, Prague, Czech Republic aut Vladyka Vilibald Department of Stereotactic and Radiation Neurosurgery, Na Homolce Hospital, Prague, Czech Republic aut Liščák Roman Department of Stereotactic and Radiation Neurosurgery, Na Homolce Hospital, Prague, Czech Republic aut Acta Neurochirurgica Springer Vienna 157/10(2015-10-01), 1783-1792 0001-6268 157:10<1783 2015 157 701 https://doi.org/10.1007/s00701-015-2525-2 text/html Onlinezugriff via DOI BK010053 XK010053 XK010000 Metadata rights reserved Springer special CC-BY-NC licence nationallicence 1 research-article jats NATIONALLICENCE NATIONALLICENCE NL-springer NATIONALLICENCE 856 40 https://doi.org/10.1007/s00701-015-2525-2 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Vojtěch Zdeněk Department of Neurology, Na Homolce Hospital, Roentgenova 2, 15030, Prague 5-Motol, Czech Republic aut NATIONALLICENCE 700 1- Malíková Hana Department of Radiodiagnostics, Na Homolce Hospital, Prague, Czech Republic aut NATIONALLICENCE 700 1- Syrůček Martin Department of Pathology, Na Homolce Hospital, Prague, Czech Republic aut NATIONALLICENCE 700 1- Krámská Lenka Department of Psychology, Na Homolce Hospital, Prague, Czech Republic aut NATIONALLICENCE 700 1- Šroubek Jan Department of Neurosurgery, Na Homolce Hospital, Prague, Czech Republic aut NATIONALLICENCE 700 1- Vladyka Vilibald Department of Stereotactic and Radiation Neurosurgery, Na Homolce Hospital, Prague, Czech Republic aut NATIONALLICENCE 700 1- Liščák Roman Department of Stereotactic and Radiation Neurosurgery, Na Homolce Hospital, Prague, Czech Republic aut NATIONALLICENCE 773 0- Acta Neurochirurgica Springer Vienna 157/10(2015-10-01), 1783-1792 0001-6268 157:10<1783 2015 157 701