Department of Neurology, Epilepsy Center Frankfurt Rhine-Main, University Hospital Frankfurt, Frankfurt am Main, Germany.
Landes-Offensive zur Entwicklung wissenschaftlich-ökonomischer Exzellen, Center for Personalized and Translational Epilepsy Research, Goethe University Frankfurt, Frankfurt am Main, Germany.
Epilepsia. 2021 Apr;62(4):831-845. doi: 10.1111/epi.16846. Epub 2021 Mar 3.
Magnetic resonance-guided laser interstitial laser therapy (MRgLITT) and radiofrequency ablation (RFA) represent two minimally invasive methods for the treatment of drug-refractory mesial temporal lobe epilepsy (mTLE). We performed a systematic review and a meta-analysis to compare outcomes and complications between MRgLITT, RFA, and conventional surgical approaches to the temporal lobe (i.e., anterior temporal lobe resection [ATL] or selective amygdalohippocampectomy [sAHE]). Forty-three studies (13 MRgLITT, 6 RFA, and 24 surgery studies) involved 554, 123, 1504, and 1326 patients treated by MRgLITT, RFA, ATL, or sAHE, respectively. Engel Class I (Engel-I) outcomes were achieved after MRgLITT in 57% (315/554, range = 33.3%-67.4%), RFA in 44% (54/123, range = 0%-67.2%), ATL in 69% (1032/1504, range = 40%-92.9%), and sAHE in 66% (887/1326, range = 21.4%-93.3%). Meta-analysis revealed no significant difference in seizure outcome between MRgLITT and RFA (Q = 2.74, p = .098), whereas ATL and sAHE were both superior to MRgLITT (ATL: Q = 8.92, p = .002; sAHE: Q = 4.33, p = .037) and RFA (ATL: Q = 6.42, p = .0113; sAHE: Q = 5.04, p = .0247), with better outcome in patients at follow-up of 60 months or more. Mesial hippocampal sclerosis (mTLE + hippocampal sclerosis) was associated with significantly better outcome after MRgLITT (Engel-I outcome in 64%; Q = 8.55, p = .0035). The rate of major complications was 3.8% for MRgLITT, 3.7% for RFA, 10.9% for ATL, and 7.4% for sAHE; the differences did not show statistical significance. Neuropsychological deficits occurred after all procedures, with left-sided surgeries having a higher rate of verbal memory impairment. Lateral functions such as naming or object recognition may be more preserved in MRgLITT. Thermal therapies are effective techniques but show a significantly lower rate of Engel-I outcome in comparison to ATL and sAHE. Between MRgLITT and RFA there were no significant differences in Engel-I outcome, whereby the success of treatment seems to depend on the approach used (e.g., occipital approach). MRgLITT shows a similar rate of complications compared to RFA, whereas patients undergoing MRgLITT may experience fewer major complications compared to ATL or sAHE and might have a more beneficial neuropsychological outcome.
磁共振引导激光间质热疗（MRgLITT）和射频消融（RFA）是治疗药物难治性内侧颞叶癫痫（mTLE）的两种微创方法。我们进行了系统评价和荟萃分析，以比较 MRgLITT、RFA 和传统的颞叶手术方法（即前颞叶切除术[ATL]或选择性杏仁核海马切除术[sAHE]）之间的结果和并发症。43 项研究（13 项 MRgLITT、6 项 RFA 和 24 项手术研究）涉及 554 例、123 例、1504 例和 1326 例分别接受 MRgLITT、RFA、ATL 或 sAHE 治疗的患者。MRgLITT 后达到 Engel Ⅰ级（Engel-I）结果的比例为 57%（315/554，范围为 33.3%-67.4%），RFA 为 44%（54/123，范围为 0%-67.2%），ATL 为 69%（1032/1504，范围为 40%-92.9%），sAHE 为 66%（887/1326，范围为 21.4%-93.3%）。荟萃分析显示，MRgLITT 和 RFA 之间的癫痫发作结果无显著差异（Q=2.74，p=0.098），而 ATL 和 sAHE 均优于 MRgLITT（ATL：Q=8.92，p=0.002；sAHE：Q=4.33，p=0.037）和 RFA（ATL：Q=6.42，p=0.0113；sAHE：Q=5.04，p=0.0247），随访 60 个月或以上的患者预后更好。内侧海马硬化（mTLE + 海马硬化）与 MRgLITT 后显著更好的结果相关（Engel-I 结果为 64%；Q=8.55，p=0.0035）。MRgLITT 的主要并发症发生率为 3.8%，RFA 为 3.7%，ATL 为 10.9%，sAHE 为 7.4%；差异无统计学意义。所有手术都会导致神经认知缺陷，左侧手术的语言记忆损伤发生率更高。命名或物体识别等侧功能可能在 MRgLITT 中保存得更好。热疗是有效的技术，但与 ATL 和 sAHE 相比，其 Engel-I 结果的发生率明显较低。MRgLITT 和 RFA 之间在 Engel-I 结果方面无显著差异，治疗的成功似乎取决于所采用的方法（例如，枕叶入路）。MRgLITT 的并发症发生率与 RFA 相似，而接受 MRgLITT 的患者与接受 ATL 或 sAHE 的患者相比，可能发生更少的主要并发症，并且可能具有更有益的神经认知结果。
