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Randomized Controlled Trial
. 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

Mark Quigg  1 , Nicholas M Barbaro  2 , Mariann M Ward  3 , Edward F Chang  3 , Donna K Broshek  4 , John T Langfitt  5 , Guofen Yan  4 , Kenneth D Laxer  6 , Andrew J Cole  7 , Penny K Sneed  3 , Christopher P Hess  3 , Wei Yu  4 , Steven A Newman  4 , Susanne Mueller  3 , Manjari Tripathi  8 , Christiaanne N Heck  9 , John W Miller  10 , Paul A Garcia  3 , Andrew McEvoy  11 , Nathan B Fountain  4 , Vincenta Salanova  2 , Robert C Knowlton  3 , Anto Bagić  12 , Thomas Henry  13 , Siddharth Kapoor  14 , Guy McKhann  15 , Adriana E Palade  16 , Markus Reuber  17 , Evelyn Tecoma  18
Affiliations
Randomized Controlled Trial

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

Mark Quigg et al. Seizure. 2018 Dec.

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.

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Conflict of interest statement

Conflicts of Interest: The authors have no significant conflicts to report.

Figures

Figure 1.
Figure 1.
Means, standard deviations, and minima/maxima of visual field defect ratios (VFDR) by treatment arm. VFDR did not differ significantly by treatment arm (P value =0.66 via Mann-Whitney U test). The incidence of abnormal visual fields determined by blinded interpretation of perimetry also did not vary significantly by arm (P value=0.65 via Fisher’s Exact Test).
Figure 2.
Figure 2.
Representative examples of the post-treatment defect volumetry following stereotactic radiosurgery (SRS) or anterior temporal lobectomy (ATL). Arrows identify areas of post-treatment volume loss. Lesion (red) corresponds to grey or white matter tissue replaced with CSF in the post-treatment MRI. Peri-lesion (blue) corresponds to necrotic tissue, i.e., white matter with hypointense appearance on a T1 weighted image, that often surrounds the CSF defect. Please see methods section for details on how these two volumes were calculated.
See this image and copyright information in PMC

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