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

Mark Quigg; Nicholas M. Barbaro; Mariann M. Ward; Edward F. Chang; Donna K. Broshek; John T. Langfitt; Guofen Yan; Kenneth D. Laxer; Andrew J. Cole; Penny K. Sneed; Christopher P. Hess; Wei Yu; Steven A. Newman; Susanne Mueller; Manjari Tripathi; Christiaanne N. Heck; John W. Miller; Paul A. Garcia; Andrew McEvoy; Nathan B. Fountain; Vincenta Salanova; Robert C. Knowlton; Anto Bagić; Thomas Henry; Siddharth Kapoor; Guy McKhann; Adriana E. Palade; Markus Reuber; Evelyn Tecoma

doi:10.1016/j.seizure.2018.10.017

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

Mark Quigg, Nicholas M. Barbaro, Mariann M. Ward, Edward F. Chang, Donna K. Broshek, John T. Langfitt, Guofen Yan, Kenneth D. Laxer, Andrew J. Cole, Penny K. Sneed, Christopher P. Hess, Wei Yu, Steven A. Newman, Susanne Mueller, Manjari Tripathi, Christiaanne N. Heck, John W. Miller, Paul A. Garcia, Andrew McEvoy, Nathan B. FountainVincenta Salanova, Robert C. Knowlton, Anto Bagić, Thomas Henry, Siddharth Kapoor, Guy McKhann, Adriana E. Palade, Markus Reuber, Evelyn Tecoma

Neurology

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11 Scopus citations

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.

Original language	English (US)
Pages (from-to)	62-67
Number of pages	6
Journal	Seizure
Volume	63
DOIs	https://doi.org/10.1016/j.seizure.2018.10.017
State	Published - Dec 2018

Bibliographical note

Funding Information:
This project was funded by NIH-NINDS R01 NS 058634-01A2 ; Elekta AB, Stockholm, Sweden .

Funding Information:
This project was funded by NIH-NINDSR01 NS 058634-01A2; Elekta AB, Stockholm, Sweden.

Publisher Copyright:
© 2018

Keywords

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

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https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6413861

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Quigg, M., Barbaro, N. M., Ward, M. M., Chang, E. F., Broshek, D. K., Langfitt, J. T., Yan, G., Laxer, K. D., Cole, A. J., Sneed, P. K., Hess, C. P., Yu, W., Newman, S. A., Mueller, S., Tripathi, M., Heck, C. N., Miller, J. W., Garcia, P. A., McEvoy, A., ... Tecoma, E. (2018). Visual field defects after radiosurgery versus temporal lobectomy for mesial temporal lobe epilepsy: Findings of the ROSE trial. Seizure, 63, 62-67. https://doi.org/10.1016/j.seizure.2018.10.017

Quigg, M, Barbaro, NM, Ward, MM, Chang, EF, Broshek, DK, Langfitt, JT, Yan, G, Laxer, KD, Cole, AJ, Sneed, PK, Hess, CP, Yu, W, Newman, SA, Mueller, S, Tripathi, M, Heck, CN, Miller, JW, Garcia, PA, McEvoy, A, Fountain, NB, Salanova, V, Knowlton, RC, Bagić, A, Henry, T, Kapoor, S, McKhann, G, Palade, AE, Reuber, M & Tecoma, E 2018, 'Visual field defects after radiosurgery versus temporal lobectomy for mesial temporal lobe epilepsy: Findings of the ROSE trial', Seizure, vol. 63, pp. 62-67. https://doi.org/10.1016/j.seizure.2018.10.017

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

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",

author = "Mark Quigg and Barbaro, {Nicholas M.} and Ward, {Mariann M.} and Chang, {Edward F.} and Broshek, {Donna K.} and Langfitt, {John T.} and Guofen Yan and Laxer, {Kenneth D.} and Cole, {Andrew J.} and Sneed, {Penny K.} and Hess, {Christopher P.} and Wei Yu and Newman, {Steven A.} and Susanne Mueller and Manjari Tripathi and Heck, {Christiaanne N.} and Miller, {John W.} and Garcia, {Paul A.} and Andrew McEvoy and Fountain, {Nathan B.} and Vincenta Salanova and Knowlton, {Robert C.} and Anto Bagi{\'c} and Thomas Henry and Siddharth Kapoor and Guy McKhann and Palade, {Adriana E.} and Markus Reuber and Evelyn Tecoma",

note = "Funding Information: This project was funded by NIH-NINDS R01 NS 058634-01A2 ; Elekta AB, Stockholm, Sweden . Funding Information: This project was funded by NIH-NINDSR01 NS 058634-01A2; Elekta AB, Stockholm, Sweden. Publisher Copyright: {\textcopyright} 2018",

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doi = "10.1016/j.seizure.2018.10.017",

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T1 - Visual field defects after radiosurgery versus temporal lobectomy for mesial temporal lobe epilepsy

T2 - Findings of the ROSE trial

AU - Quigg, Mark

AU - Barbaro, Nicholas M.

AU - Ward, Mariann M.

AU - Chang, Edward F.

AU - Broshek, Donna K.

AU - Langfitt, John T.

AU - Yan, Guofen

AU - Laxer, Kenneth D.

AU - Cole, Andrew J.

AU - Sneed, Penny K.

AU - Hess, Christopher P.

AU - Yu, Wei

AU - Newman, Steven A.

AU - Mueller, Susanne

AU - Tripathi, Manjari

AU - Heck, Christiaanne N.

AU - Miller, John W.

AU - Garcia, Paul A.

AU - McEvoy, Andrew

AU - Fountain, Nathan B.

AU - Salanova, Vincenta

AU - Knowlton, Robert C.

AU - Bagić, Anto

AU - Henry, Thomas

AU - Kapoor, Siddharth

AU - McKhann, Guy

AU - Palade, Adriana E.

AU - Reuber, Markus

AU - Tecoma, Evelyn

N1 - Funding Information: This project was funded by NIH-NINDS R01 NS 058634-01A2 ; Elekta AB, Stockholm, Sweden . Funding Information: This project was funded by NIH-NINDSR01 NS 058634-01A2; Elekta AB, Stockholm, Sweden. Publisher Copyright: © 2018

PY - 2018/12

Y1 - 2018/12

N2 - 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.

AB - 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.

KW - Epilepsy surgery

KW - Mesial temporal lobe epilepsy

KW - Partial seizures

KW - Radiosurgery

KW - Randomized controlled trial

KW - Visual field defects

KW - gamma knife

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ER -

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

Abstract

Bibliographical note

Keywords

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