Sinclair Georges, Martin Heather, Shamikh Alia, Samadi Amir, Cooray Gerald, Bartek Jiri, Al-Saffar Yehya, Svensson Mikael, Dodoo Ernest
Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden.
Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden.
Surg Neurol Int. 2017 Aug 9;8:174. doi: 10.4103/sni.sni_482_16. eCollection 2017.
Dysembryoplastic neuroepithelial tumors (DNT/DNET) are rare epileptogenic tumors. Microsurgery remains the best treatment option, although case reports exist on the use of gamma knife radiosurgery (GKRS) in selected cases. We investigated the long-term outcome of GKRS-treated DNTs at our institution in the context of current diagnostic and treatment options.
We conducted a retrospective review of three consecutive adult patients (≥18 years) treated with salvage GKRS between 2002 and 2010 at Karolinska University Hospital, Stockholm, Sweden. The case series was supplemented by a review of current literature. A 20-year-old male underwent subtotal resection (STR) in 1997 and 2002 of DNT resulting in temporary control of intractable epilepsy despite antiepileptic drug treatment (AED). Long-term seizure control was obtained after GKRS of two separate residual DNT components along the surgical margin (2005 and 2010). A 27-year-old male undergoing gross total resection of the contrast-enhancing portion of a DNT (1999) resulted in temporary control of intractable epilepsy despite AEDs; lasting clinical control of seizures was achieved in 2002 after GKRS of a small, recurrent DNT component. A 28-year-old male underwent STR of DNT (1994 and 2004) resulting in temporary control of intractable epilepsy. Lasting seizure control was gained after GKRS of a residual tumor (2005).
GKRS as performed in our series was effective in terms of tumor and seizure control. No adverse radiation effects were recorded. Prospective studies are warranted to establish the role of GKRS in the treatment of DNTs.
胚胎发育不良性神经上皮肿瘤（DNT/DNET）是罕见的致痫性肿瘤。显微手术仍然是最佳治疗选择，尽管有在特定病例中使用伽玛刀放射外科手术（GKRS）的病例报告。我们在当前诊断和治疗选择的背景下，研究了我院采用GKRS治疗DNT的长期疗效。
我们对2002年至2010年期间在瑞典斯德哥尔摩卡罗林斯卡大学医院接受挽救性GKRS治疗的3例连续成年患者（≥18岁）进行了回顾性研究。该病例系列辅以对当前文献的综述。一名20岁男性在1997年和2002年对DNT进行了次全切除（STR），尽管使用了抗癫痫药物治疗（AED），但仍暂时控制了难治性癫痫。在沿着手术边缘对两个单独的残留DNT成分进行GKRS治疗后（2005年和2010年），获得了长期癫痫控制。一名27岁男性对DNT的强化部分进行了全切除（1999年），尽管使用了AED，但仍暂时控制了难治性癫痫；在对一个小的复发性DNT成分进行GKRS治疗后，于2002年实现了癫痫发作的持久临床控制。一名28岁男性对DNT进行了STR（1994年和2004年），暂时控制了难治性癫痫。在对残留肿瘤进行GKRS治疗后（2005年），获得了持久的癫痫控制。
我们系列中所进行的GKRS在肿瘤和癫痫控制方面是有效的。未记录到不良放射效应。有必要进行前瞻性研究以确定GKRS在DNT治疗中的作用。
