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.

内窥镜癫痫手术是一种快速兴起的微创手术,可替代开放手术。该入路最大限度地减少了骨和脑的切除,降低了手术的发病率。本系统综述和荟萃分析旨在评估内窥镜癫痫手术患者癫痫发作改善的有利结果。直到2023年1月,两位独立研究人员使用PubMed和Web of Science进行了搜索,以找到报告内窥镜癫痫手术患者结果的研究。我们从符合条件的研究中提取了患者的临床概况和结局数据。15项研究纳入了340例患者,其中293例接受了内窥镜癫痫手术。患者队列包括189名(55.6%)男性。171例(58.3例)患者获得Engel I或II或> 90%癫痫控制的良好结果。我们的荟萃分析纳入了13项研究,结果显示内窥镜癫痫手术后癫痫发作控制得到改善,总癫痫发作自由率为58% (95% CI: 0.43-0.71, i2 = 77.1%, τ 2 = 0.6836)。针对儿科人群的研究报告了更高比例的阳性结果,为73.27% (95% CI: 62-82%, i2 = 0.0%)。相比之下,混合年龄人群的成功率较低,为48% (95% CI: 32-65%, i2 = 79.0%)。此外,儿童和混合年龄组的治疗结果有显著差异(p = 0.014)。下丘脑错构瘤(HH)患者群体的预后良好比例为61.71% (95% CI: 48.92 ~ 73.06%),异质性中等(I 2 = 62.9%, tau 2 = 0.4266)。5例患者出现术后并发症,3例死亡。我们的研究结果表明,内窥镜癫痫手术在儿科人群和HH患者中特别有效,强调了在临床决策中考虑患者人口统计学和疾病特征的重要性。研究的异质性需要谨慎解释汇总结果,提倡在治疗计划中采用量身定制的方法。与公认的开放手术技术相比,内窥镜癫痫手术的作用需要前瞻性试验来建立I级证据。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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