Department of Neurology, The First Hospital of Lanzhou University, Lanzhou, Gansu, 730000, People's Republic of China.
Neurosurg Rev. 2023 Apr 18;46(1):91. doi: 10.1007/s10143-023-01997-3.
Posttraumatic epilepsy (PTE) accounts for approximately 20% of structural epilepsy, and surgical intervention may be a potential treatment option for these patients. Therefore, the purpose of this meta-analysis is to evaluate the effectiveness of surgical interventions for the management of PTE. Four electronic databases (Pubmed, Embase, Scopus and Cochrane library) were searched to identify studies on surgical management of PTE. Seizures reduction rate were analyzed quantitatively in a meta-analysis. Fourteen studies involving 430 PTE patients were selected for analysis, out of which 12 reported on resective surgery (RS), 2 on vagus nerve stimulation (VNS), and 2 of the 12 RS studies reported that 14 patients underwent VNS. The seizure reduction rate for surgical interventions (both RS and VNS) was 77.1% (95% confidence interval [CI]: 69.8%-83.7%) with moderate heterogeneity (I = 58.59%, P = 0.003). Subgroup analysis based on different follow-up times revealed that the seizure reduction rate was 79.4% (95% CI: 69.1%-88.2%) within 5 years and 71.9% (95% CI: 64.5%-78.8%) beyond 5 years. The seizure reduction rate for RS alone was 79.9% (95% CI: 70.3%-88.2%) with high heterogeneity (I = 69.85%, P = 0.001). Subgroup analysis showed that the seizure reduction rate was 77.9% (95% CI: 66%-88.1%) within 5 years and 85.6% (95% CI: 62.4%-99.2%) beyond 5 years, with 89.9% (95% CI: 79.2%-97.5%) for temporal lobectomy and 84% (95% CI: 68.2%-95.9%) for extratemporal lobectomy. The seizure reduction rate for VNS alone was 54.5% (95% CI: 31.6%-77.4%). Surgical interventions appeared to be effective for PTE patients without severe complications, RS seemed more beneficial than VNS, while temporal lobectomy is more favorable than extratemporal resection. However, further studies with long-term follow-up data are needed to better understand the relationship between VNS and PTE.
创伤后癫痫（PTE）约占结构性癫痫的 20%，手术干预可能是这些患者的潜在治疗选择。因此，本荟萃分析的目的是评估手术干预治疗 PTE 的效果。我们检索了四个电子数据库（Pubmed、Embase、Scopus 和 Cochrane 图书馆），以确定关于 PTE 手术管理的研究。通过荟萃分析定量分析了癫痫发作减少率。从 14 项研究中选择了 430 名 PTE 患者进行分析，其中 12 项报告了切除术（RS），2 项报告了迷走神经刺激术（VNS），12 项 RS 研究中有 2 项报告 14 名患者接受了 VNS。手术干预（RS 和 VNS）的癫痫发作减少率为 77.1%（95%置信区间[CI]：69.8%-83.7%），存在中度异质性（I=58.59%，P=0.003）。基于不同随访时间的亚组分析显示，5 年内癫痫发作减少率为 79.4%（95%CI：69.1%-88.2%），5 年以上为 71.9%（95%CI：64.5%-78.8%）。单独使用 RS 的癫痫发作减少率为 79.9%（95%CI：70.3%-88.2%），异质性较高（I=69.85%，P=0.001）。亚组分析显示，5 年内癫痫发作减少率为 77.9%（95%CI：66%-88.1%），5 年以上为 85.6%（95%CI：62.4%-99.2%），颞叶切除术为 89.9%（95%CI：79.2%-97.5%），颞叶外切除术为 84%（95%CI：68.2%-95.9%）。单独使用 VNS 的癫痫发作减少率为 54.5%（95%CI：31.6%-77.4%）。手术干预似乎对没有严重并发症的 PTE 患者有效，RS 似乎比 VNS 更有益，而颞叶切除术比颞叶外切除术更有利。然而，需要进一步的长期随访数据研究来更好地理解 VNS 与 PTE 之间的关系。
