Ekman Felix R, Bjellvi Johan, Ljunggren Sofia, Malmgren Kristina, Nilsson Daniel
Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden.
World Neurosurg. 2024 Dec;192:224-235.e15. doi: 10.1016/j.wneu.2024.09.090. Epub 2024 Oct 22.
Epilepsy surgery offers a vital treatment option for drug-resistant mesial temporal lobe epilepsy, with temporal lobe resection (TLR) and magnetic resonance-guided laser interstitial thermal therapy (MRgLITT) being fundamental interventions. This meta-analysis specifically examines seizure outcomes at extended follow-up periods exceeding 24 months, visual field deficits as measured by perimetry, and complication rates both overall and categorized based on duration as minor (transient <6 months) or major (persistent >6 months) to inform clinical decision-making. For seizure freedom, TLR was superior, with 72.5% [65.6%, 78.5%] of patients achieving postoperative seizure freedom compared to 57.1% [51.2%, 62.7%] for MRgLITT (P value <0.01). Visual field deficits were observed in 79.4% [59.5%, 91.0%] of TLR patients and 49.8% [23.6%, 76.0%] of MRgLITT patients, a difference not reaching statistical significance (P value: 0.08). Overall complication rates were 11.4% [7.4%, 17.2%] for TLR and 6.5% [3.3%, 12.3%] for MRgLITT (P value 0.15). Major complications occurred in 2.0% [1.1%, 3.09%] of TLR cases and 2.7% [1.4%, 5.2%] of MRgLITT cases (P value 0.54), while minor complications were significantly more frequent with TLR at 9.9% [6.4%, 15.0%] versus MRgLITT's 4.1% [1.9%, 8.4%] (P value 0.04). MRgLITT had a more favorable outcome regarding confrontation naming, while more studies are needed regarding verbal memory to be able to draw firm conclusions. TLR provides superior seizure freedom but comes with an increased risk of transient complications. Although there was no statistical significance in visual field deficits, the trend suggests a higher frequency with TLR. The study's extensive data analysis, including rigorous sensitivity checks, ensures the robustness of these conclusions, reflecting a comprehensive analysis of the available data at this time point.
癫痫手术为耐药性内侧颞叶癫痫提供了一种重要的治疗选择，颞叶切除术（TLR）和磁共振引导激光间质热疗（MRgLITT）是基本的干预措施。这项荟萃分析专门研究了超过24个月的延长随访期的癫痫发作结果、通过视野计测量的视野缺损以及总体并发症发生率，并根据持续时间分为轻微（短暂性<6个月）或严重（持续性>6个月），以指导临床决策。对于癫痫发作缓解，TLR更具优势，72.5%[65.6%，78.5%]的患者术后实现癫痫发作缓解，而MRgLITT为57.1%[51.2%，62.7%]（P值<0.01）。79.4%[59.5%，91.0%]的TLR患者和49.8%[23.6%，76.0%]的MRgLITT患者出现视野缺损，差异无统计学意义（P值：0.08）。TLR的总体并发症发生率为11.4%[7.4%，17.2%]，MRgLITT为6.5%[3.3%，12.3%]（P值0.15）。严重并发症在2.0%[1.1%，3.09%]的TLR病例和2.7%[1.4%，5.2%]的MRgLITT病例中发生（P值0.54），而轻微并发症在TLR中明显更频繁，为9.9%[6.4%，15.0%]，而MRgLITT为4.1%[1.9%，8.4%]（P值0.04）。在对答命名方面，MRgLITT有更有利的结果，而关于言语记忆则需要更多研究才能得出确凿结论。TLR提供了更好的癫痫发作缓解，但伴有短暂并发症风险增加。虽然视野缺损无统计学意义，但趋势表明TLR出现频率更高。该研究的广泛数据分析，包括严格的敏感性检查，确保了这些结论的稳健性，反映了在这个时间点对现有数据的全面分析。
