Khoudari Hamza, Alabbas Mohammad, Tobochnik Steven, Burneo Jorge, Cox Benjamin, Lemus Hernan Nicolas
University of Debrecen, Debrecen, Hungary.
Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts, USA.
Epilepsia. 2025 Apr;66(4):945-954. doi: 10.1111/epi.18264. Epub 2025 Jan 16.
Temporal encephaloceles (TEs) are seen in patients with drug-resistant epilepsy (DRE); yet they are also common incidental findings. Variability in institutional pre-surgical epilepsy practices and interpretation of epileptogenic network localization contributes to bias in existing epilepsy cohorts with TE, and therefore the relevance of TE in DRE remains controversial. We sought to estimate effect sizes and sample sizes necessary to demonstrate clinically relevant improvements in seizure outcome with different surgical approaches.
We searched Medline, Embase, and Cochrane to identify studies reporting the outcomes of epilepsy surgery after 12 months in patients with DRE and TE. The main outcome was seizure freedom or favorable seizure outcome. We also assessed the rates of seizure freedom among patients with DRE, TE, and the following covariables: use of intracranial electroencephalography (iEEG), side of the encephalocele, sex, and type of surgical resection (anterior temporal lobectomy [ATL] vs lesionectomy). Random-effects meta-analysis was used to calculate the proportion of patients attaining seizure outcomes.
We identified 332 studies, of which 15 (282 patients) met inclusion criteria for meta-analysis. Seizure-freedom rate was 65% (95% confidence interval [CI] 53-76), whereas the favorable outcome rate was 78% (95% CI 70-85). There was no significant interstudy heterogeneity. Patients with TE undergoing iEEG (risk ratio [RR] 0.80, 95% CI 0.74-0.87) had a lower chance of a favorable seizure outcome. A power analysis estimated a sample size of 28 932 patients with TE (13 764 with ATL) necessary to determine a significant difference in seizure freedom between limited resection and ATL.
Retrospective cohort studies demonstrate good outcomes after TE resection regardless of the extent of resection. Prohibitively large sample sizes necessary to observe outcome differences between surgical approaches and presurgical predictors indicate that improved biomarkers and mechanistic understanding of TE epileptogenicity are needed.
颞叶脑膨出（TEs）可见于耐药性癫痫（DRE）患者；但它们也是常见的偶然发现。机构术前癫痫治疗方法的差异以及癫痫源网络定位的解读导致现有TE癫痫队列存在偏差，因此TE在DRE中的相关性仍存在争议。我们试图估计不同手术方法在癫痫发作结局方面显示出临床相关改善所需的效应大小和样本量。
我们检索了Medline、Embase和Cochrane数据库，以识别报告DRE和TE患者术后12个月癫痫手术结局的研究。主要结局是癫痫发作缓解或良好的癫痫发作结局。我们还评估了DRE、TE患者以及以下协变量的癫痫发作缓解率：颅内脑电图（iEEG）的使用、脑膨出的侧别、性别和手术切除类型（前颞叶切除术[ATL]与病灶切除术）。采用随机效应荟萃分析来计算达到癫痫发作结局的患者比例。
我们识别出332项研究，其中15项（282例患者）符合荟萃分析的纳入标准。癫痫发作缓解率为65%（95%置信区间[CI]53 - 76），而良好结局率为78%（95%CI 70 - 85）。研究间无显著异质性。接受iEEG检查的TE患者（风险比[RR]0.80，95%CI 0.74 - 0.87）获得良好癫痫发作结局的可能性较低。功效分析估计，要确定有限切除与ATL在癫痫发作缓解方面的显著差异，需要28932例TE患者（13764例接受ATL）的样本量。
回顾性队列研究表明，无论切除范围如何，TE切除术后结局良好。观察手术方法和术前预测指标之间的结局差异所需的样本量过大，这表明需要改进生物标志物并加深对TE致痫性的机制理解。
