nmpЖурнал им. Н.В. Склифосовского «Неотложная медицинская помощь»Russian Sklifosovsky Journal "Emergency Medical Care"2223-90222541-8017“N.V. Sklifosovsky Research Institute for Emergency Medicine”10.23934/2223-9022-2021-10-1-73-82nmp-1075Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИORIGINAL ARTICLESСтереотаксическая радиохирургия в комплексном лечении пациентов с эпилепсией, ассоциированной с различными структурными поражениями головного мозгаStereotactic Radiosurgery in the Complex Treatment of Patients With Epilepsy Associated With Various Structural Brain Lesionshttps://orcid.org/0000-0003-4136-628XКрыловВ. В.KrylovV. V.

доктор медицинских наук, академик РАН, директор клинического медицинского центра

Российская Федерация, 127473, Москва, ул. Делегатская, д. 20, стр. 1 

Doctor of Medical Sciences, Member of the Russian Academy of Sciences, Doctor of Medicine

20, bldg. 1 Delegatskaya St., Moscow, 127473, Russian Federation

krylov@neurosklif.ruhttps://orcid.org/0000-0002-4534-8719РакВ. А.RakV. A.

 врач-нейрохирург Центра радиохирургии

Российская Федерация, 129090, Москва, Б. Сухаревская пл., д. 3 

 Neurosurgeon 

3 B. Sukharevskaya Sq., Moscow, 129090, Russian Federation 

rak@neurosklif.ruhttps://orcid.org/0000-0002-8415-5602ТокаревА. С.TokarevA. S.

кандидат медицинских наук, научный сотрудник отделения неотложной нейрохирургии

Российская Федерация, 129090, Москва, Б. Сухаревская пл., д. 3 

 Candidate of Medical Sciences, Researcher, Department of Emergency Neurosurgery 

3 B. Sukharevskaya Sq., Moscow, 129090, Russian Federation 

tokarev@neurosklif.ruhttps://orcid.org/0000-0001-5026-0060СинкинМ. В.SinkinM. V.

кандидат медицинских наук, старший научный сотрудник отделения неотложной нейрохирургииРоссийская Федерация, 127473, Москва, ул. Делегатская, д. 20, стр. 1 Российская Федерация, 129090, Москва, Б. Сухаревская пл., д. 3 

 Candidate of Medical Sciences, Senior Researcher, Department of Emergency Neurosurgery 

20, bldg. 1 Delegatskaya St., Moscow, 127473, Russian Federation3 B. Sukharevskaya Sq., Moscow, 129090, Russian Federation 

mvsinkin@gmail.comhttps://orcid.org/0000-0002-6911-0975ТрифоновИ. С.TrifonovI. S.

кандидат медицинских наук, врач-нейрохирург, ФГБОУ ВО «МГМСУ им. А.И. Евдокимова»Российская Федерация, 127473, Москва, ул. Делегатская, д. 20, стр. 1 

Candidate of Medical Sciences, Neurosurgeon

20, bldg. 1 Delegatskaya St., Moscow, 127473, Russian Federation

dr.trifonov@mail.ruhttps://orcid.org/0000-0001-8099-9544ЕвдокимоваО. Л.YevdokimovaO. L.

заведующая Центром радиохирургии

Российская Федерация, 129090, Москва, Б. Сухаревская пл., д. 3 

Head of the Radiosurgery Center

3 B. Sukharevskaya Sq., Moscow, 129090, Russian Federation 

liveryevna@yandex.ruhttps://orcid.org/0000-0003-0007-8054СтепановВ. Н.StepanovV. N.

врач-рентгенолог Центра радиохирургии

Российская Федерация, 129090, Москва, Б. Сухаревская пл., д. 3 

 Radiologist

3 B. Sukharevskaya Sq., Moscow, 129090, Russian Federation 

stepanovvn@sklif.mos.ruhttps://orcid.org/0000-0003-0521-4836РожноваЕ. Н.RozhnovaE. N.

врач-невролог Центра радиохирургии

Российская Федерация, 129090, Москва, Б. Сухаревская пл., д. 3 

 Neurologist at the Center for Radiosurgery

3 B. Sukharevskaya Sq., Moscow, 129090, Russian Federation  

elizabett-eliz@yandex.ruhttps://orcid.org/0000-0001-9507-0797КойнашГ. В.KoinashG. V.

 медицинский физик Центра радиохирургии

Российская Федерация, 129090, Москва, Б. Сухаревская пл., д. 3 

  Medical Physicist, Radiosurgery Center 

3 B. Sukharevskaya Sq., Moscow, 129090, Russian Federation 

g.koynash@gmail.comЦентр радиохирургии, ФГБОУ ВО «Московский государственный медико-стоматологический университет им. А.Е. Евдокимова» Минздрава РоссииРоссияRadiosurgery Center, A.E. Yevdokimov Moscow State University of Medicine and Dentistry of the Ministry of Health of Russian FederationRussian FederationГБУЗ «Научно-исследовательский институт скорой помощи им. Н.В. Склифосовского ДЗМ»РоссияN.V. Sklifosovsky Research Institute for Emergency Medicine of the Moscow Health DepartmentRussian FederationЦентр радиохирургии, ФГБОУ ВО «Московский государственный медико-стоматологический университет им. А.Е. Евдокимова» Минздрава России; ГБУЗ «Научно-исследовательский институт скорой помощи им. Н.В. Склифосовского ДЗМ»РоссияRadiosurgery Center, A.E. Yevdokimov Moscow State University of Medicine and Dentistry of the Ministry of Health of Russian Federation; N.V. Sklifosovsky Research Institute for Emergency Medicine of the Moscow Health DepartmentRussian Federation2021160420211017382Copyright © Крылов В.В., Рак В.А., Токарев А.С., Синкин М.В., Трифонов И.С., Евдокимова О.Л., Степанов В.Н., Рожнова Е.Н., Койнаш Г.В., 20212021Крылов В.В., Рак В.А., Токарев А.С., Синкин М.В., Трифонов И.С., Евдокимова О.Л., Степанов В.Н., Рожнова Е.Н., Койнаш Г.В.Krylov V.V., Rak V.A., Tokarev A.S., Sinkin M.V., Trifonov I.S., Yevdokimova O.L., Stepanov V.N., Rozhnova E.N., Koinash G.V.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.jnmp.ru/jour/article/view/1075

АКТУАЛЬНОСТЬ    Структурное поражение вещества головного мозга у взрослых является одной из наиболее частых причин возникновения эпилепсии. В настоящее время таким пациентам назначается лекарственная терапия и/или хирургическое лечение. При таком подходе эпилептические приступы могут сохраняться у значительной части пациентов (до 30% в зависимости от заболевания).

ЦЕЛЬ    Уточнить эффективность стереотаксической радиохирургии (СРХ) в составе комплексного лечения пациентов, страдающих фармакорезистентной симптоматической эпилепсией при склерозе гиппокампа, сосудистых мальформациях, некоторых доброкачественных опухолях головного мозга и его оболочек.

МАТЕРИАЛ И МЕТОДЫ    Проведено обследование и радиохирургическое лечение 45 пациентов с различными заболеваниями головного мозга, сопровождающимися симптоматической эпилепсией, при условии недостаточной эффективности ранее перенесенного консервативного или хирургического лечения. На протяжении срока наблюдения произведена оценка частоты приступов и зафиксированы наличие и характер послеоперационных осложнений.

РЕЗУЛЬТАТЫ    При медиане срока наблюдения 30 месяцев хорошие исходы (класс I–II по шкале J. Engel) отмечены у 5 из 8 пациентов со склерозом гиппокампа, перенесших СРХ после амигдалогиппокамплобэктомии; частота приступов снизилась у всех пациентов. Осложнения СРХ отмечены у 2 пациентов и имели транзиторный характер. В группе пациентов с менингиомами у 4 из 8 пациентов приступы полностью прекратились, у 3 пациентов частота приступов снизилась более чем на 90%, еще у 1 больного частота приступов снизилась на 60%. Осложнений СРХ за время срока наблюдения выявлено не было. При внутримозговых опухолях (диффузная астроцитома) исход Engel Ia отмечен у обоих пациентов. В группе пациентов с кавернозными ангиомами — хорошие исходы (I–II класс по шкале J. Engel) у 17 пациентов (85%). Ухудшение состояния (исход Engel IVc) наблюдали у 1 пациента (5%), у 2 пациентов (10%) развились осложнения СРХ. В группе пациентов с артериовенозными мальформациями хорошие исходы (I–II классы по шкале J. Engel) — у всех 7 пациентов. У 1 пациента выявлено осложнение после СРХ.

ВЫВОДЫ    Представленные результаты подтверждают высокую эффективность и низкий риск побочных эффектов при использовании стереотаксической радиохирургии в комплексном лечении пациентов с эпилепсией, ассоциированной с часто встречающимися структурными поражениями головного мозга.

BACKGROUND Structural damage to the brain substance in adults is one of the most common causes of epilepsy. Currently, such patients are prescribed drug therapy and/or surgery. With this approach, epileptic symptoms can persist in a significant proportion of patients (up to 30%, depending on the disease).

AIM OF STUDY To clarify the efficacy of stereotactic radiosurgery (STS) as part of the complex treatment of patients suffering from pharmacoresistant symptomatic epilepsy with hippocampal sclerosis, vascular malformations, and some benign tumors of the brain and its membranes.

MATERIAl AND METHODS Examination and radiosurgical treatment were carried out in 45 patients with various brain diseases accompanied by symptomatic epilepsy, provided that the previous conservative or surgical treatment was insufficiently effective. During the observation period, the frequency of seizures was assessed and the presence and nature of postoperative complications were recorded.

RESUlTS With a median follow-up of 30 months, good outcomes (class I–II according to J. Engel’s scale) were observed in 5 out of 8 patients with hippocampal sclerosis who underwent STS after  amygdaloghippocamplobectomy; seizure frequency decreased in all patients. Complications of STS were noted in 2 patients and had a transient nature. In the group of patients with meningiomas, in 4 out of 8 patients, seizures completely stopped, in 3 patients the frequency of seizures decreased by more than 90%, in another 1 the frequency of seizures decreased by 60%. There were no complications of STS during the observation period. Inintracerebral tumors (diffuse astrocytoma), Engel Ia outcome was observed in both patients. In the group of patients with cavernous angiomas, there were good outcomes (class I–II according to J. Engel’s scale) in 17 patients (85%). Deterioration (Engel IVc outcome) was observed in 1 patient (5%), 2 patients (10%) had complications of STS. In the group of patients with arteriovenous malformations, good outcomes (classes I–II according to J. Engel’s scale) were found in all 7 patients. The complication after STS was revealed in 1 patient.

CONClUSION The presented results confirm the high efficiency and low risk of side effects when using stereotactic radiosurgery in the complex treatment of patients with epilepsy associated with common structural brain lesions.

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The authors declare that there are no conflicts of interest present.