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Seizure. 2018 Dec;63:62-67. doi: 10.1016/j.seizure.2018.10.017. Epub 2018 Oct 31.

Visual field defects after radiosurgery versus temporal lobectomy for mesial temporal lobe epilepsy: Findings of the ROSE trial.

Author information

1
University of Virginia, Charlottesville, VA, United States. Electronic address: quigg@virginia.edu.
2
Indiana University, Indianapolis, IN, United States.
3
University of California San Francisco, San Francisco, CA, United States.
4
University of Virginia, Charlottesville, VA, United States.
5
University of Rochester, Rochester, NY, United States.
6
California Pacific Medical Center, San Francisco, CA, United States.
7
Massachusetts General Hospital, Boston, MA, United States.
8
All India Institute of Medical Science, New Delhi, India.
9
University of Southern California, Los Angeles, CA, United States.
10
University of Washington, Seattle, WA, United States.
11
University College London, London, United Kingdom.
12
University of Pittsburgh, PA, United States.
13
University of Minnesota, Minneapolis, MN, United States.
14
University of Kentucky, Lexington, KY, United States.
15
Columbia University, New York, NY, United States.
16
University of Louisville, Louisville, KY, United States.
17
University of Sheffield, Sheffield, United Kingdom.
18
University of California San Diego, San Diego, CA, United States.

Abstract

PURPOSE:

Stereotactic radiosurgery (SRS) may be an alternative to anterior temporal lobectomy (ATL) for mesial temporal lobe epilepsy (MTLE). Visual field defects (VFD) occur in 9-100% of patients following open surgery for MTLE. Postoperative VFD after minimally invasive versus open surgery may differ.

METHODS:

This prospective trial randomized patients with unilateral hippocampal sclerosis and concordant video-EEG findings to SRS versus ATL. Humphries perimetry was obtained at 24 m after surgery. VFD ratios (VFDR = proportion of missing homonymous hemifield with 0 = no VFD, 0.5 = complete superior quadrantanopsia) quantified VFD. Regressions of VFDR were evaluated against treatment arm and covariates. MRI evaluated effects of volume changes on VFDR. The relationships of VFDR with seizure remission and driving status 3 years after surgery were evaluated.

RESULTS:

No patients reported visual changes or had abnormal bedside examinations, but 49 of 54 (91%) of patients experienced VFD on formal perimetry. Neither incidence nor severity of VFDR differed significantly by treatment arm. VFDR severity was not associated with seizure remission or driving status.

CONCLUSION:

The nature of VFD was consistent with lesions of the optic radiations. Effective surgery (defined by seizure remission) of the mesial temporal lobe results in about a 90% incidence of typical VFD regardless of method.

KEYWORDS:

Epilepsy surgery; Mesial temporal lobe epilepsy; Partial seizures; Radiosurgery; Randomized controlled trial; Visual field defects; gamma knife

PMID:
30408713
DOI:
10.1016/j.seizure.2018.10.017
[Indexed for MEDLINE]

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