Tsalouchidou Panagiota-Eleni, Matsingos Alexandros, Hahn Wiebke, Menzler Katja, Knake Susanne
Epilepsy Center Hessen, Department of Neurology, Philipps University Marburg, Marburg, Germany.
Second Department of Neurology, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece.
Epilepsia Open. 2025 Apr 10. doi: 10.1002/epi4.70036.
Temporal encephaloceles (TEs) are increasingly recognized as a cause of MRI-negative temporal lobe epilepsy (TLE). The optimal surgical approach for TE-related refractory epilepsy remains unclear, particularly regarding the necessity of excluding mesiotemporal structures such as the hippocampus, which may lead to worse neuropsychological outcomes. This study evaluates the impact of hippocampectomy on achieving seizure freedom in patients with TE-related epilepsy through a systematic review and individual participant data (IPD) meta-analysis.
A systematic literature review was conducted across Medline, Google Scholar, Embase, and Web of Science, identifying studies reporting surgical outcomes in TE-related epilepsy. Studies were included if they provided at least 12 months of follow-up and reported seizure outcomes using Engel or ILAE classification. The primary outcome was postsurgical seizure freedom (Engel Class IA or ILAE Class 1). A mixed-effects logistic regression model was used to compare outcomes between patients who underwent hippocampectomy and those who did not. Heterogeneity was assessed using τ and I statistics.
The meta-analysis included 23 studies with a total of 155 surgically treated patients. The primary analysis did not identify a statistically significant difference in seizure freedom between patients who underwent hippocampectomy and those who did not (Risk Ratio [RR] = 0.66, 95% Confidence Interval [CI]: 0.29-1.52, p = 0.329). Other covariates, including sex, duration of epilepsy, presence of additional epileptogenic lesions, and the use of invasive presurgical evaluation, were not significant predictors of seizure freedom. The I statistic indicated moderate heterogeneity (54.68%).
This IPD meta-analysis suggests that hippocompectomy does not significantly impact seizure freedom in patients with TE-related epilepsy and should not be part of a universal approach when determining the optimal surgical strategy. These results reinforce the need for an individualized approach, considering patient-specific factors to optimize surgical decision-making in TE-related epilepsy.
Temporal encephaloceles (TEs) can cause drug-resistant epilepsy, often requiring surgical management for seizure control. Given the variety of surgical techniques available, the optimal approach remains uncertain, particularly regarding the necessity of hippocampectomy, which may impact neuropsychological outcomes. This one-stage individual participant data meta-analysis found no significant difference in seizure freedom between patients who underwent hippocampectomy and those who did not. These findings suggest that hippocampectomy should not be routinely performed and highlight the importance of individualized surgical decision-making for patients with TEs.
颞叶脑膨出（TEs）越来越被认为是MRI阴性颞叶癫痫（TLE）的一个病因。对于与TE相关的难治性癫痫，最佳手术方法仍不明确，特别是在是否有必要排除海马等颞叶内侧结构方面，这可能会导致更差的神经心理学结果。本研究通过系统评价和个体参与者数据（IPD）荟萃分析，评估海马切除术对与TE相关癫痫患者实现无癫痫发作的影响。
对Medline、谷歌学术、Embase和科学网进行系统的文献综述，识别报告与TE相关癫痫手术结果的研究。如果研究提供至少12个月的随访，并使用恩格尔或国际抗癫痫联盟（ILAE）分类报告癫痫发作结果，则纳入研究。主要结局是术后无癫痫发作（恩格尔IA级或ILAE 1级）。使用混合效应逻辑回归模型比较接受海马切除术和未接受海马切除术患者的结局。使用τ和I统计量评估异质性。
荟萃分析纳入23项研究，共155例接受手术治疗的患者。初步分析未发现接受海马切除术和未接受海马切除术的患者在无癫痫发作方面存在统计学显著差异（风险比[RR]=0.66，95%置信区间[CI]：0.29-1.52，p=0.329）。其他协变量，包括性别、癫痫持续时间、是否存在其他致痫性病变以及术前侵入性评估的使用，均不是无癫痫发作的显著预测因素。I统计量表明存在中度异质性（54.68%）。
这项IPD荟萃分析表明，海马切除术对与TE相关癫痫患者的无癫痫发作没有显著影响，在确定最佳手术策略时不应作为通用方法的一部分。这些结果强化了采用个体化方法的必要性，即考虑患者的具体因素以优化与TE相关癫痫的手术决策。
颞叶脑膨出（TEs）可导致药物难治性癫痫，通常需要手术治疗来控制癫痫发作。鉴于可用的手术技术多种多样，最佳方法仍不确定，特别是在海马切除术的必要性方面，这可能会影响神经心理学结果。这项单阶段个体参与者数据荟萃分析发现，接受海马切除术和未接受海马切除术的患者在无癫痫发作方面没有显著差异。这些发现表明，不应常规进行海马切除术，并强调了对TE患者进行个体化手术决策的重要性。
