Pendl G, Eder H G, Schroettner O, Leber K A
Department of Neurosurgery, Karl-Franzens University, Graz, Austria.
Neurosurgery. 1999 Aug;45(2):303-7; discussion 307-8. doi: 10.1097/00006123-199908000-00021.
Corpus callosotomy is a surgical option for medically uncontrolled generalized epilepsy in appropriate patients. Because numerous complications related to open callosotomy are still reported, we performed radiosurgical corpus callosotomy with the gamma knife.
Between October 1992 and June 1995, three patients underwent stereotactic radiosurgery to ablate the anterior third of the corpus callosum. The patients had intractable epilepsy: two had Lennox-Gastaut syndrome, and one had multifocal epilepsy with atonic, tonicoclonic, and atypical absence seizures. The history of seizures ranged from 20 to 37 years' duration. Stereotactic radiosurgery was performed with a cobalt-60 gamma knife using a 4-mm collimator, targeted to the rostrum, genu, and anterior third of body of the corpus callosum. Two patients were treated once with 150 and 160 Gy at maximum, respectively, and one patient was treated in two stages with 50 Gy and then 170 Gy at maximum.
The severity and frequency of seizures were significantly reduced in all three patients. The types of seizures associated with the most improved outcome were atonic and generalized tonicoclonic seizures. The mean follow-up period was 38 months. Hospitalization required for this procedure was 3 days. No complications related to irradiation were recorded except transient headache in one patient.
The outcomes suggest that radiosurgical corpus callosotomy may be a promising alternative treatment to open callosotomy.
胼胝体切开术是适合患者药物治疗无法控制的全身性癫痫的一种手术选择。由于仍有大量与开放性胼胝体切开术相关的并发症报告，我们采用伽玛刀进行了立体定向放射外科胼胝体切开术。
1992年10月至1995年6月期间，3例患者接受了立体定向放射外科手术，以切除胼胝体前三分之一。这些患者患有难治性癫痫：2例患有Lennox-Gastaut综合征，1例患有多灶性癫痫，伴有失张力、强直阵挛和非典型失神发作。癫痫病史持续时间为20至37年。使用钴-60伽玛刀，采用4毫米准直器进行立体定向放射外科手术，靶点为胼胝体的嘴部、膝部和体部前三分之一。2例患者分别单次接受最大剂量150和160 Gy的治疗，1例患者分两阶段治疗，先接受50 Gy，然后最大剂量为170 Gy。
所有3例患者癫痫发作的严重程度和频率均显著降低。改善最明显的发作类型为失张力发作和全身性强直阵挛发作。平均随访期为38个月。该手术所需住院时间为3天。除1例患者出现短暂头痛外，未记录到与放疗相关的并发症。
结果表明，立体定向放射外科胼胝体切开术可能是开放性胼胝体切开术一种有前景的替代治疗方法。
