Service de Neurochirurgie fonctionnelle et stéréotaxique, CHU La Timone, 264, rue Saint-Pierre, 13385 Marseille Cedex 05.
There is a strong rationale for investigation of the role of gamma knife radiosurgery in the treatment of medically intractable epilepsy. To explore this potential application, the current outcome and morbidity associated with established microsurgical treatment, as well as the associated advantages and disadvantages of open surgery, are reviewed. The preliminary evidence in support of radiosurgical treatment and the recent experience with gamma knife treatment for epilepsy associated with mesial temporal sclerosis, cavernous angioma, and hypothalamic hamartoma or other lesions are presented. The strengths and limitations of this application are discussed, and the challenges facing both microsurgical and radiosurgical approaches are considered. Gamma knife surgery can be a main approach among others in the arma-mentarium of epilepsy surgery. Although the benefits of comfort and reduced invasivity can be clearly perceived, larger series and long-term follow up are still required in order to evaluate the future of this particular surgical approach.