{"id":20382,"date":"2026-03-24T21:15:52","date_gmt":"2026-03-24T21:15:52","guid":{"rendered":"https:\/\/cancercentertec100.com\/?p=20382"},"modified":"2026-03-24T21:23:14","modified_gmt":"2026-03-24T21:23:14","slug":"radiocirugia_estereotactica","status":"publish","type":"post","link":"https:\/\/cancercentertec100.com\/en\/radiocirugia\/radiocirugia_estereotactica\/","title":{"rendered":"RADIOCIRUG\u00cdA ESTEREOT\u00c1CTICA EN EPILEPSIA FOCAL REFRACTARIA"},"content":{"rendered":"
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Por: Dr. Rodrigo Uribe Pacheco
Neurocirujano
<\/em><\/span><\/figure>\n
La epilepsia farmacorresistente es una condici\u00f3n neurol\u00f3gica cr\u00f3nica caracterizada por la persistencia de crisis epil\u00e9pticas a pesar del uso adecuado de al menos dos f\u00e1rmacos antiepil\u00e9pticos bien tolerados y apropiadamente seleccionados. Esta condici\u00f3n afecta aproximadamente al 30% de los pacientes con epilepsia, con un impacto
significativo en la calidad de vida y el funcionamiento social, laboral y cognitivo.\u00a0<\/p>\n

 <\/p>\n

La radiocirug\u00eda estereot\u00e1ctica (SRS, por sus siglas en ingl\u00e9s) ha emergido como una alternativa terap\u00e9utica no invasiva en casos cuidadosamente seleccionados de epilepsia refractaria, particularmente en pacientes con:
\u2022 Epilepsia del l\u00f3bulo temporal mesial (MTLE) con evidencia de esclerosis hipocampal.
\u2022 Hamartomas hipotal\u00e1micos, causantes de epilepsias gel\u00e1sticas.
\u2022 Crisis focales en localizaciones elocuentes o en pacientes con alto riesgo quir\u00fangico.<\/p>\n

Mecanismo y T\u00e9cnica<\/strong><\/span>
La SRS permite administrar haces altamente enfocados de radiaci\u00f3n ionizante a un blanco epil\u00e9ptico previamente definido, principalmente en la regi\u00f3n mesial del l\u00f3bulo temporal. Su mecanismo de acci\u00f3n incluye tanto efectos ablativos directos a dosis altas como efectos neuromoduladores a dosis subnecr\u00f3ticas, como la reducci\u00f3n de la densidad neuronal, la esclerosis perivascular y cambios en los neurotransmisores que suprimen la actividad epilept\u00f3gena sin comprometer las funciones adyacentes [1].<\/p>\n

Modelos experimentales y datos cl\u00ednicos sugieren que el control de crisis puede lograrse incluso con dosis subnecr\u00f3ticas, y que la aparici\u00f3n de edema vasog\u00e9nico est\u00e1 correlacionada con el inicio de la remisi\u00f3n de crisis, que usualmente ocurre entre los 9 y 12 meses posteriores al tratamiento [1][2].<\/p>\n

Las dosis comunes utilizadas en MTLE se sit\u00faan entre 20 y 25 Gy dirigidas al hipocampo y am\u00edgdala mediante sistemas como Gamma Knife\u00ae o colimadores de cono en acelerador lineal.<\/p>\n

Indicaciones y Evaluaci\u00f3n Previa<\/strong><\/span>
Los candidatos ideales para SRS son aquellos con epilepsia focal farmacorresistente que no son aptos para cirug\u00eda resectiva por:
\u2022 Localizaci\u00f3n del foco en corteza elocuente.
\u2022 Comorbilidades m\u00e9dicas relevantes.
\u2022 Preferencia por una opci\u00f3n no invasiva.<\/p>\n

La evaluaci\u00f3n prequir\u00fargica debe ser integral e incluir:
\u2022 Video EEG prolongado.
\u2022 Resonancia magn\u00e9tica de alta resoluci\u00f3n.
\u2022 Evaluaci\u00f3n neuropsicol\u00f3gica detallada.<\/p>\n

Efectividad Cl\u00ednica<\/strong><\/span>
En MTLE, se ha documentado:
\u25e6 Remisi\u00f3n completa de crisis en 50-60% de los casos [5][2][6].
\u25e6 Reducci\u00f3n >50% en la frecuencia de crisis en 70-80% de los pacientes.
\u25e6 Tiempo promedio para m\u00e1xima eficacia: 12-14 meses post-tratamiento [2].<\/p>\n

En hamartomas hipotal\u00e1micos:<\/strong><\/span>
\u25e6 Control significativo de crisis en m\u00e1s del 60% de los casos.
\u25e6 Mejoras en el comportamiento y funciones cognitivas [4].<\/p>\n

Ventajas de la SRS<\/span><\/strong>
\u2022 Procedimiento no invasivo, sin necesidad de craneotom\u00eda.
\u2022 Menor riesgo de deterioro neuropsicol\u00f3gico.
\u2022 Alta precisi\u00f3n anat\u00f3mica y preservaci\u00f3n de estructuras vecinas.
\u2022 Recuperaci\u00f3n r\u00e1pida y menor tiempo de hospitalizaci\u00f3n.<\/p>\n

Consideraciones y Riesgos<\/span><\/strong>
\u2022 Latencia terap\u00e9utica: efecto cl\u00ednico retardado (6-12 meses).
\u2022 Posibles efectos adversos:
\u25e6 Edema cerebral tard\u00edo.
\u25e6 Cuadrantanopsia superior hasta en 50% de los casos.
\u25e6 Deterioro de la memoria verbal (mayor si el foco est\u00e1 en hemisferio dominante).
\u25e6 Cefalea (hasta 85%).
\u25e6 Riesgo bajo de necrosis por radiaci\u00f3n o formaci\u00f3n de quistes [3][7][5][6].
\u2022 Alrededor del 20% de los pacientes pueden requerir cirug\u00eda adicional por persistencia de crisis o complicaciones [6].<\/p>\n

Conclusi\u00f3n<\/span><\/strong>
La SRS representa una opci\u00f3n terap\u00e9utica eficaz, segura y menos invasiva para pacientes con epilepsia focal farmacorresistente, en especial en MTLE y en pacientes con hamartomas hipotal\u00e1micos. Aunque su eficacia en el control de crisis es inferior a la lobectom\u00eda temporal anterior, ofrece un perfil de efectos secundarios m\u00e1s favorable y se justifica especialmente en pacientes no candidatos a cirug\u00eda abierta [3][4][6].<\/p>\n

Referencias:<\/span><\/strong><\/span><\/div>\n
    \n
  1. \n

    Romanelli P, Anschel DJ. Radiosurgery for Epilepsy. The Lancet. Neurology. 2006;5(7):613-20. doi:10.1016\/S1474-4422(06)70496-3.<\/span><\/p>\n<\/li>\n

  2. \n

    Chang EF, Quigg M, Oh MC, et al. Predictors of Efficacy After Stereotactic Radiosurgery for Medial Temporal Lobe Epilepsy. Neurology. 2010;74(2):165-72. doi:10.1212\/WNL.0b013e3181c9185d.<\/span><\/p>\n<\/li>\n

  3. \n

    Daly SR, Soto JM, Gonzalez SM, et al. Stereotactic Radiosurgery for Medically Refractory Non-Lesional Epilepsy: A Case-Based Radiosurgery Society (RSS) Practice Review. Clinical Neurology and Neurosurgery. 2024;246:108550. doi:10.1016\/j.clineuro.2024.108550.<\/span><\/p>\n<\/li>\n

  4. \n

    McGonigal A, Sahgal A, De Salles A, et al. Radiosurgery for Epilepsy: Systematic Review and International Stereotactic Radiosurgery Society (ISRS) Practice Guideline. Epilepsy Research. 2017;137:123-131. doi:10.1016\/j.eplepsyres.2017.08.016.<\/span><\/p>\n<\/li>\n

  5. \n

    Feng ES, Sui CB, Wang TX, Sun GL. Stereotactic Radiosurgery for the Treatment of Mesial Temporal Lobe Epilepsy. Acta Neurologica Scandinavica. 2016;134(6):442-451. doi:10.1111\/ane.12562.<\/span><\/p>\n<\/li>\n

  6. \n

    Eekers DBP, Pijnappel EN, Schijns OEMG, et al. Evidence on the Efficacy of Primary Radiosurgery or Stereotactic Radiotherapy for Drug-Resistant Non-Neoplastic Focal Epilepsy in Adults: A Systematic Review. Seizure. 2018;55:83-92. doi:10.1016\/j.seizure.2018.01.009.<\/span><\/p>\n<\/li>\n

  7. \n

    Ryvlin P, Cross JH, Rheims S. Epilepsy Surgery in Children and Adults. The Lancet. Neurology. 2014;13(11):1114-1126. doi:10.1016\/S1474-4422(14)70156-5.<\/span><\/p>\n<\/li>\n<\/ol>\n<\/figure>\n

    <\/figure>\n<\/div>\n<\/div><\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"

    La epilepsia farmacorresistente es una condici\u00f3n neurol\u00f3gica cr\u00f3nica caracterizada por la persistencia de crisis epil\u00e9pticas a pesar del uso adecuado de al menos dos f\u00e1rmacos antiepil\u00e9pticos bien tolerados y apropiadamente seleccionados. Esta condici\u00f3n afecta aproximadamente al 30% de los pacientes con epilepsia, con un impacto significativo en la calidad de vida y el funcionamiento social, laboral y cognitivo.<\/p>","protected":false},"author":1,"featured_media":20383,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[394],"tags":[391,384],"class_list":["post-20382","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-radiocirugia","tag-radiocirugia","tag-tratamiento-cancer"],"yoast_head":"\nRADIOCIRUG\u00cdA ESTEREOT\u00c1CTICA EN EPILEPSIA FOCAL REFRACTARIA<\/title>\n<meta name=\"description\" content=\"La epilepsia farmacorresistente es una condici\u00f3n neurol\u00f3gica cr\u00f3nica caracterizada por la persistencia de crisis epil\u00e9pticas a pesar del uso adecuado de al menos dos f\u00e1rmacos antiepil\u00e9pticos bien tolerados y apropiadamente seleccionados. 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