Endoscopic Epilepsy Surgery: Systematic Review and Meta-Analysis.

Asian journal of neurosurgery Pub Date : 2024-10-28 eCollection Date: 2025-03-01 DOI:10.1055/s-0044-1791996
F N U Ruchika, Jitender Chaturvedi, Malla Bhaskara Rao, Shiv Kumar Mudgal, Mritunjai Kumar, Mohit Gupta, Rahul Singh, Priyanka Gupta, Sanjay Agrawal
{"title":"Endoscopic Epilepsy Surgery: Systematic Review and Meta-Analysis.","authors":"F N U Ruchika, Jitender Chaturvedi, Malla Bhaskara Rao, Shiv Kumar Mudgal, Mritunjai Kumar, Mohit Gupta, Rahul Singh, Priyanka Gupta, Sanjay Agrawal","doi":"10.1055/s-0044-1791996","DOIUrl":null,"url":null,"abstract":"<p><p>Endoscopic epilepsy surgery is a fast emerging minimally invasive alternative to open surgery. The approach minimizes the extent of bone and brain resection and reduces surgical morbidity. This systematic review and meta-analysis sought to evaluate the favorable outcome of seizure improvement in patients undergoing endoscopic epilepsy surgery. The search was conducted by two independent researchers using PubMed and Web of Science until January 2023 to find studies reporting results of patients who underwent endoscopic epilepsy surgery. We extracted data on the clinical profile and outcomes of the patients from the eligible studies. Fifteen studies yielded 340 patients, of which 293 underwent endoscopic epilepsy surgery. The patient cohort consisted of 189 (55.6%) males. A total of 171 (58.3) patients had a favorable outcome of either Engel I or II or > 90% seizure control. Thirteen studies were included in our meta-analysis, and demonstrated improved seizure control after endoscopic epilepsy surgery, with a pooled seizure freedom rate of 58% (95% CI: 0.43-0.71, I <sup>2</sup>  = 77.1%, τ <sup>2</sup>  = 0.6836). Studies focusing on pediatric populations reported a higher proportion of positive outcomes, with a rate of 73.27% (95% CI: 62-82%, I <sup>2</sup>  = 0.0%). In comparison, mixed-age populations showed a lower success rate of 48% (95% CI: 32-65%, I <sup>2</sup>  = 79.0%). Furthermore, there was significant difference in treatment outcomes between the pediatric and mixed age groups ( <i>p</i>  = 0.014). The hypothalamic hamartomas (HH) patient population demonstrated a favorable outcome proportion of 61.71% (95% CI: 48.92-73.06%), with a moderate level of heterogeneity ( <i>I</i> <sup>2</sup>  = 62.9%, tau <sup>2</sup>  = 0.4266). Five patients developed postoperative complications, and there were three deaths. Our findings suggest that endoscopic epilepsy surgery is particularly effective in pediatric populations and among patients with HH, underscoring the importance of considering patient demographics and disease characteristics in clinical decision-making. The heterogeneity across studies necessitates cautious interpretation of the pooled results, advocating for tailored approaches in treatment planning. Prospective trials are required to establish class I evidence for the role of endoscopic epilepsy surgery compared with the recognized open surgical techniques.</p>","PeriodicalId":94300,"journal":{"name":"Asian journal of neurosurgery","volume":"20 1","pages":"10-19"},"PeriodicalIF":0.0000,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11875714/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Asian journal of neurosurgery","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1055/s-0044-1791996","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/3/1 0:00:00","PubModel":"eCollection","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0

Abstract

Endoscopic epilepsy surgery is a fast emerging minimally invasive alternative to open surgery. The approach minimizes the extent of bone and brain resection and reduces surgical morbidity. This systematic review and meta-analysis sought to evaluate the favorable outcome of seizure improvement in patients undergoing endoscopic epilepsy surgery. The search was conducted by two independent researchers using PubMed and Web of Science until January 2023 to find studies reporting results of patients who underwent endoscopic epilepsy surgery. We extracted data on the clinical profile and outcomes of the patients from the eligible studies. Fifteen studies yielded 340 patients, of which 293 underwent endoscopic epilepsy surgery. The patient cohort consisted of 189 (55.6%) males. A total of 171 (58.3) patients had a favorable outcome of either Engel I or II or > 90% seizure control. Thirteen studies were included in our meta-analysis, and demonstrated improved seizure control after endoscopic epilepsy surgery, with a pooled seizure freedom rate of 58% (95% CI: 0.43-0.71, I 2  = 77.1%, τ 2  = 0.6836). Studies focusing on pediatric populations reported a higher proportion of positive outcomes, with a rate of 73.27% (95% CI: 62-82%, I 2  = 0.0%). In comparison, mixed-age populations showed a lower success rate of 48% (95% CI: 32-65%, I 2  = 79.0%). Furthermore, there was significant difference in treatment outcomes between the pediatric and mixed age groups ( p  = 0.014). The hypothalamic hamartomas (HH) patient population demonstrated a favorable outcome proportion of 61.71% (95% CI: 48.92-73.06%), with a moderate level of heterogeneity ( I 2  = 62.9%, tau 2  = 0.4266). Five patients developed postoperative complications, and there were three deaths. Our findings suggest that endoscopic epilepsy surgery is particularly effective in pediatric populations and among patients with HH, underscoring the importance of considering patient demographics and disease characteristics in clinical decision-making. The heterogeneity across studies necessitates cautious interpretation of the pooled results, advocating for tailored approaches in treatment planning. Prospective trials are required to establish class I evidence for the role of endoscopic epilepsy surgery compared with the recognized open surgical techniques.

求助全文
约1分钟内获得全文 求助全文
来源期刊
自引率
0.00%
发文量
0
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术官方微信