Brotis Alexandros G, Giannis Theofanis, Paschalis Thanos, Kapsalaki Eftychia, Dardiotis Efthymios, Fountas Konstantinos N
Departments of Neurosurgery, University Hospital of Larissa, School of Medicine, University of Thessaly, Larissa, Greece.
Departments of Neurosurgery, University Hospital of Larissa, School of Medicine, University of Thessaly, Larissa, Greece.
Clin Neurol Neurosurg. 2021 Apr 20;205:106644. doi: 10.1016/j.clineuro.2021.106644.
The efficacy of laser interstitial thermal therapy (LITT) in mesial temporal lobe epilepsy (MTLE) has not been clearly established yet.
We conducted a meta-analysis to estimate the efficacy of LITT for TLE (Q1). We also examined the effect of the patient's age (Q2), the total ablation volume (TAV) (Q3), the strength of the MRI unit (Q4), the type of the utilized stereotactic platform (Q5), and the follow up period (Q6) on the patient's outcome.
Fixed- and random-effects model meta-analysis was conducted to assess the proportion estimate for each parameter individually. Kaplan-Meier survival-analysis was performed on the available individual patient time-to-first seizure data.
Sixteen studies with 575 patients fulfilled our eligibility criteria. The efficacy of LITT was 0.547 (95%CI: 0.506-0.588). Our statistical analysis had robust results after stratification according to the study population (Q2; p = 0.3418), and the type of the utilized stereotactic platform (Q5; p = 0.286), whereas the role of the TAV (Q3; p = 0.058) and strength of the magnetic field (Q4; p = 0.062) in seizure control remained unclear. The median seizure-free period (Q6) was 0.643 (0.569-0.726) and 0.467 (0.385-0.566) for the one- and the two-year follow up.
LITT seems to offer a viable alternative to resective surgery, with a moderate efficacy and enduring results. Higher ablation volumes may be associated with improved seizure control, although our current study provided no statistically significant data. More high-quality studies are required to highlight the role of LITT in epilepsy surgery, particularly in the pediatric population.
激光间质热疗法（LITT）治疗内侧颞叶癫痫（MTLE）的疗效尚未明确确立。
我们进行了一项荟萃分析，以评估LITT治疗颞叶癫痫（Q1）的疗效。我们还研究了患者年龄（Q2）、总消融体积（TAV）（Q3）、磁共振成像（MRI）设备强度（Q4）、所使用的立体定向平台类型（Q5）以及随访期（Q6）对患者预后的影响。
采用固定效应和随机效应模型荟萃分析分别评估每个参数的比例估计值。对可用的个体患者首次发作时间数据进行Kaplan-Meier生存分析。
16项研究共575例患者符合我们的纳入标准。LITT的疗效为0.547（95%置信区间：0.506 - 0.588）。根据研究人群（Q2；p = 0.3418）和所使用的立体定向平台类型（Q5；p = 0.286）进行分层后，我们的统计分析结果可靠，而TAV（Q3；p = 0.058）和磁场强度（Q4；p = 0.062）在癫痫控制中的作用仍不明确。一年和两年随访的无癫痫发作期中位数（Q6）分别为0.643（0.569 - 0.726）和0.467（0.385 - 0.566）。
LITT似乎为切除性手术提供了一种可行的替代方法，具有中等疗效和持久效果。更高的消融体积可能与更好的癫痫控制相关，尽管我们目前的研究未提供具有统计学意义的数据。需要更多高质量研究来突出LITT在癫痫手术中的作用，特别是在儿科人群中。
