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

Mark Quigg, Nicholas 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. FountainVicenta Salanova, Robert C. Knowlton, Anto Bagić, Thomas Henry, Siddharth Kapoor, Guy McKhann, Adriana E. Palade, Markus Reuber, Evelyn Tecoma

Research output: Contribution to journalArticle

1 Citation (Scopus)

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 languageEnglish (US)
Pages (from-to)62-67
Number of pages6
JournalSeizure
Volume63
DOIs
StatePublished - Dec 1 2018

Fingerprint

Temporal Lobe Epilepsy
Radiosurgery
Visual Fields
Anterior Temporal Lobectomy
Visual Field Tests
Seizures
Hemianopsia
Incidence
Sclerosis
Temporal Lobe
Electroencephalography
Radiation
Therapeutics

Keywords

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

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology

Cite this

Quigg, M., Barbaro, N., Ward, M. M., Chang, E. F., Broshek, D. K., Langfitt, J. T., ... 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

Visual field defects after radiosurgery versus temporal lobectomy for mesial temporal lobe epilepsy : Findings of the ROSE trial. / Quigg, Mark; Barbaro, Nicholas; Ward, Mariann M.; Chang, Edward F.; Broshek, Donna K.; Langfitt, John T.; Yan, Guofen; Laxer, Kenneth D.; Cole, Andrew J.; Sneed, Penny K.; Hess, Christopher P.; Yu, Wei; Newman, Steven A.; Mueller, Susanne; Tripathi, Manjari; Heck, Christiaanne N.; Miller, John W.; Garcia, Paul A.; McEvoy, Andrew; Fountain, Nathan B.; Salanova, Vicenta; Knowlton, Robert C.; Bagić, Anto; Henry, Thomas; Kapoor, Siddharth; McKhann, Guy; Palade, Adriana E.; Reuber, Markus; Tecoma, Evelyn.

In: Seizure, Vol. 63, 01.12.2018, p. 62-67.

Research output: Contribution to journalArticle

Quigg, M, Barbaro, N, 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
Quigg, Mark ; Barbaro, Nicholas ; Ward, Mariann M. ; Chang, Edward F. ; Broshek, Donna K. ; Langfitt, John T. ; Yan, Guofen ; Laxer, Kenneth D. ; Cole, Andrew J. ; Sneed, Penny K. ; Hess, Christopher P. ; Yu, Wei ; Newman, Steven A. ; Mueller, Susanne ; Tripathi, Manjari ; Heck, Christiaanne N. ; Miller, John W. ; Garcia, Paul A. ; McEvoy, Andrew ; Fountain, Nathan B. ; Salanova, Vicenta ; Knowlton, Robert C. ; Bagić, Anto ; Henry, Thomas ; Kapoor, Siddharth ; McKhann, Guy ; Palade, Adriana E. ; Reuber, Markus ; Tecoma, Evelyn. / Visual field defects after radiosurgery versus temporal lobectomy for mesial temporal lobe epilepsy : Findings of the ROSE trial. In: Seizure. 2018 ; Vol. 63. pp. 62-67.
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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.",
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TY - JOUR

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

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, Vicenta

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

PY - 2018/12/1

Y1 - 2018/12/1

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 - gamma knife

KW - Mesial temporal lobe epilepsy

KW - Partial seizures

KW - Radiosurgery

KW - Randomized controlled trial

KW - Visual field defects

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