Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
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A Potential Risk of Radiation-Induced Cavernous Malformations Following Adjuvant Gamma Knife Radiosurgery for Mesial Temporal Lobe Epilepsy

  • Junhyung Kim (Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Joonho Byun (Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Do Heui Lee (Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Seok Ho Hong (Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine)
  • Received : 2023.09.21
  • Accepted : 2023.11.03
  • Published : 2024.07.01
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Abstract

Objective : Several clinical studies have explored the feasibility and efficacy of radiosurgical treatment for mesial temporal lobe epilepsy, but the long-term safety of this treatment has not been fully characterized. This study aims to report and describe radiation-induced cavernous malformation as a delayed complication of radiosurgery in epilepsy patients. Methods : The series includes 20 patients with mesial temporal lobe epilepsy who underwent Gamma Knife radiosurgery (GKRS). The majority received a prescribed isodose of 24 Gy as an adjuvant treatment after anterior temporal lobectomy. Results : In this series, we identified radiation-induced cavernous malformation in three patients, resulting in a cumulative incidence of 18.4% (95% confidence interval, 6.3% to 47.0%) at an 8-year follow-up. These late sequelae of vascular malformation occurred between 6.9 and 7.6 years after GKRS, manifesting later than other delayed radiation-induced changes, such as radiation necrosis. Neurological symptoms attributed to intracranial hypertension were present in those three cases involving cavernous malformation. Of these, two cases, which initially exhibited an insufficient response to radiosurgery, ultimately demonstrated seizure remission following the successful microsurgical resection of the cavernous malformation. Conclusion : All things considered, the development of radiation-induced cavernous malformation is not uncommon in this population and should be acknowledged as a potential long-term complication. Microsurgical resection of cavernous malformation can be preferentially considered in cases where the initial seizure outcome after GKRS is unsatisfactory.

Keywords

Acknowledgement

The authors would like to extend their deep admiration and gratitude to Jung Kyo Lee, a senior functional neurosurgeon, for his substantial contribution to this institution's epilepsy program. This study was presented at the 63rd Annual Meeting of the Korean Neurosurgical Society in Seoul, Korea.

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