Mohsen Youstina, Sarhan Khalid, Alawadi Ibrahim Saleh, Elmahdi Reem Reda, Kozaa Yasmeena Abdelall, Gomaa Menna A, Serag Ibrahim, Shahein Mostafa
Mansoura Manchester Program for Medical Education, Faculty of Medicine, Mansoura University, Mansoura, Egypt.
Faculty of Medicine, Mansoura University, Mansoura, Egypt.
Neurosurg Rev. 2025 Jan 21;48(1):71. doi: 10.1007/s10143-025-03215-8.
Epilepsy is a common neurological disease that is treated with medications; however, patients with drug-resistant epilepsy, commonly intractable temporal lobe epilepsy, tend to have better control with surgical treatment. While the mainstay of surgical treatment is anterior temporal lobectomy, it carries risk of potential adverse effects hence minimally invasive techniques are now being used as an alternative to open surgery. This systematic review and meta-analysis compare the efficacy and safety of three of the most used techniques: laser interstitial thermal therapy (LITT), radiofrequency ablation (RFA) and stereotactic radiosurgery (SRS). Multiple databases were searched and PRISMA guidelines were followed to make an indirect meta-analysis using the currently available studies for the three techniques in terms of seizure freedom, risk of major complications and reoperations. Further subgroup analyses were carried out for LITT in terms of follow up periods and seizure freedom in patients with or without hippocampal sclerosis. A total of 42 papers were included in this study with a total of 1675 patients (1303 treated by LITT, 188 treated by RFA and 184 treated by SRS). LITT had the highest rate of seizure freedom (55.0%, CI 51.5 - 58.5%, P = 0.148), and the lowest rates of major complications (2.3%, CI 1.2 - 3.5%, P = 0.070), and reoperations (14.3%, CI 10.4 - 18.3%, P = 0.042) compared to RFA and SRS which had seizure freedom of 46.3% (CI 18.8 - 73.7%, P = 0.000) and 53.8% (CI 44.4 - 63.3%; I^2 = 40.4%, P = 0.098), major complication rate of 3.9% (CI 0.7 - 7.0%; I^2 = 0%, P = 0.458) and 14.3% (CI 3.1 - 25.5%, P = 0.000) and reoperation rate of 28.6% (CI -4.3 - 61.5%, P = 0.000) and 15.4% (CI 6.1 - 24.8%; I^2 = 0%, P = 0.392) respectively. In conclusion, LITT showed the highest rate of seizure freedom and the lowest rate of major complications and reoperations compared to RFA and SRS in single-arm studies of intractable mesial temporal lobe epilepsy. However, the lack of direct comparisons between treatment modalities limits definitive conclusions. Despite this, LITT appears to offer a favorable safety profile, warranting further prospective, comparative studies to validate these findings.
癫痫是一种常见的神经系统疾病，通常采用药物治疗；然而，耐药性癫痫患者，常见的是难治性颞叶癫痫，手术治疗往往能更好地控制病情。虽然手术治疗的主要方法是前颞叶切除术，但它存在潜在不良反应的风险，因此现在微创技术正被用作开放手术的替代方法。本系统评价和荟萃分析比较了三种最常用技术的疗效和安全性：激光间质热疗（LITT）、射频消融（RFA）和立体定向放射外科（SRS）。检索了多个数据库，并遵循PRISMA指南，利用目前关于这三种技术在无癫痫发作、主要并发症风险和再次手术方面的现有研究进行间接荟萃分析。对LITT进行了进一步的亚组分析，涉及随访期以及有无海马硬化患者的无癫痫发作情况。本研究共纳入42篇论文，总计1675例患者（1303例接受LITT治疗，188例接受RFA治疗，184例接受SRS治疗）。与RFA和SRS相比，LITT的无癫痫发作率最高（55.0%，CI 51.5 - 58.5%，P = 0.148），主要并发症发生率最低（2.3%，CI 1.2 - 3.5%，P = 0.070），再次手术率最低（14.3%，CI 10.4 - 18.3%，P = 0.042），而RFA和SRS的无癫痫发作率分别为46.3%（CI 18.8 - 73.7%，P = 0.000）和53.8%（CI 44.4 - 63.3%；I^2 = 40.4%，P = 0.098），主要并发症发生率分别为3.9%（CI 0.7 - 7.0%；I^2 = 0%，P = 0.458）和14.3%（CI 3.1 - 25.5%，P = 0.000），再次手术率分别为28.6%（CI -4.3 - 61.5%，P = 0.000）和15.4%（CI 6.1 - 24.8%；I^2 = 0%，P = 0.392）。总之，在难治性内侧颞叶癫痫的单臂研究中，与RFA和SRS相比，LITT显示出最高的无癫痫发作率以及最低的主要并发症发生率和再次手术率。然而，治疗方式之间缺乏直接比较限制了得出确定性结论。尽管如此，LITT似乎具有良好的安全性，值得进一步进行前瞻性、比较性研究以验证这些发现。
