Functional Neurosurgery Department, National Children's Health Center of China, Beijing Children's Hospital, Capital Medical University, Beijing, China.
Department of Neurosurgery, David Geffen School of Medicine at University of California, Los Angeles, CA, United States of America.
Seizure. 2023 May;108:81-88. doi: 10.1016/j.seizure.2023.04.002. Epub 2023 Apr 4.
To perform a systematic review and meta-analysis to identify whether tuberectomy and tuberectomy plus are associated with different postoperative seizure outcomes in patients with tuberous sclerosis complex (TSC) -related epilepsy.
Electronic databases (PubMed, Embase, Cochrane, Proquest, Web of Science, Scopus, Biosis Previews) were searched without date restriction. Retrospective cohort studies of participants with TSC-associated epilepsy undergoing resective surgery that reported demographics, presurgical evaluation, extent of resection and postoperative seizure outcomes were included. Title, abstract and the full text were checked independently and in duplicate by two reviewers. Disagreements were resolved through discussion. One author extracted data which was verified by a second author using identified common standard in advance, including using a risk of bias tool we agreed on to evaluate study quality.
Five studies, with a total of 327 participants, were included. One hundred and sixty patients received tuberectomy, and 93 of them (58.1%) achieved postoperative seizure freedom, while the other 167 patients underwent tuberectomy plus, and 128 of them (76.6%) achieved seizure freedom after adequate follow-ups (RR=0.72, 95% CI [0.60, 0.87], P<0.05). Subgroup analysis found that 40 of 63 (63.5%) patients after tuberectomy and 66 of 78 (84.6%) patients after tuberectomy plus of a single tuber achieved seizure freedom (RR = 0.71, 95% CI [0.56,0.91], P<0.05). In the multituber subrgroup, 16 of 42 (38.1%) and 21 of 31 (67.7%) patients achieved seizure freedom, after tuberectomy and tuberectomy plus, respectively (RR = 0.57, 95% CI [0.32,1.03], P = 0.06).
Tuberectomy plus is a more effective treatment than tuberectomy for patients with TSC-related intractable epilepsy.
系统回顾和荟萃分析，以确定结节性硬化症（TSC）相关癫痫患者行结节切除术和结节切除术加术后是否存在不同的术后癫痫发作结果。
无时间限制地检索电子数据库（PubMed、Embase、Cochrane、Proquest、Web of Science、Scopus、Biosis Previews）。纳入了接受切除术治疗且报告了人口统计学、术前评估、切除范围和术后癫痫发作结果的 TSC 相关癫痫患者的回顾性队列研究。标题、摘要和全文由两名审查员独立和重复检查。通过讨论解决分歧。一名作者提取数据，另一名作者使用事先确定的通用标准进行验证，包括使用我们同意的风险偏倚工具来评估研究质量。
共纳入 5 项研究，共计 327 名参与者。160 名患者接受了结节切除术，其中 58.1%（160 名中的 93 名）术后无癫痫发作，而另外 167 名患者接受了结节切除术加，其中 76.6%（167 名中的 128 名）在充分随访后无癫痫发作（RR=0.72，95%CI[0.60，0.87]，P<0.05）。亚组分析发现，40 名接受结节切除术的患者中有 63.5%（40/63）和 78 名接受结节切除术加的患者中有 84.6%（66/78）在单个结节后实现了癫痫无发作（RR=0.71，95%CI[0.56，0.91]，P<0.05）。在多结节亚组中，分别有 38.1%（42 名中的 16 名）和 67.7%（31 名中的 21 名）的患者在接受结节切除术和结节切除术加后实现了癫痫无发作（RR=0.57，95%CI[0.32，1.03]，P=0.06）。
对于 TSC 相关难治性癫痫患者，结节切除术加比结节切除术更有效。
