Efficacy and safety of MR guided-laser interstitial thermal therapy versus resective surgery for MRI-positive focal cortical dysplasia type II and tuberous sclerosis complex: A systematic review and meta-analysis.
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引用次数: 0
Abstract
Background: Focal cortical dysplasia type II (FCD II) and tuberous sclerosis complex (TSC) are two major structural causes of drug-resistant epilepsy. While the effectiveness of surgical resection in controlling seizures is well-established, the comparative efficacy and safety profile of magnetic resonance-guided laser interstitial thermal therapy (MRgLITT) has not been thoroughly investigated.
Objective: To compare the efficacy and safety of MRgLITT with resective surgery in patients with MRI-positive FCD II and TSC.
Design: A systematic review and meta-analysis was conducted with all available randomized clinical trials and observational studies.
Materials and methods: A systematic literature search was conducted across four databases: PubMed, Web of Science, the Cochrane Library, and Embase. Study quality was assessed with the ROBINS-I V2 tool. The primary outcome was the postoperative seizure freedom rate, and the secondary outcome was the complication rate.
Results: Overall, 36 studies were included, comprising 25 on resective surgery (1220 patients) and 13 on MRgLITT (87 patients), with two studies reporting data on both surgical modalities. No significant difference was observed in seizure freedom rates between MRgLITT and resective surgery for the combined FCD II/TSC group (0.72 vs. 0.71, P = 0.838), the FCD II-only (0.74 vs. 0.85, P = 0.065), and the TSC-only (0.50 vs. 0.59, P = 0.510), respectively. Surgery age-based subgroup (<18 vs. ≥18 years) analysis also revealed no significant difference in seizure freedom. Similarly, in the combined FCD II/TSC group, complication rates did not differ significantly between MRgLITT and resective surgery (P = 0.469).
Conclusion: Both resective surgery and MRgLITT are effective treatment options for epilepsy caused by MRI-positive FCD II and TSC, demonstrating comparable efficacy in seizure control and safety. Postoperative seizure outcomes were not influenced by patient age group.
背景：局灶性皮质发育不良II型（FCD II）和结节性硬化症（TSC）是耐药性癫痫的两个主要结构性病因。虽然手术切除在控制癫痫发作方面的有效性是公认的，但磁共振引导的激光间质热治疗（MRgLITT）的相对疗效和安全性尚未得到彻底的研究。目的：比较MRgLITT与切除手术治疗mri阳性FCD II和TSC患者的疗效和安全性。设计：对所有可用的随机临床试验和观察性研究进行系统回顾和荟萃分析。材料和方法：对四个数据库进行了系统的文献检索：PubMed、Web of Science、Cochrane Library和Embase。采用ROBINS-I V2工具评估研究质量。主要观察指标为术后癫痫发作自由率，次要观察指标为并发症发生率。结果：总共纳入了36项研究，包括25项切除手术（1220例患者）和13项MRgLITT（87例患者），其中2项研究报告了两种手术方式的数据。在FCD II/TSC联合组、FCD II组（0.74 vs. 0.85, P = 0.065）和TSC组（0.50 vs. 0.59, P = 0.510）中，MRgLITT与切除手术的癫痫发作自由率差异无统计学意义（P = 0.838）。结论：切除手术和MRgLITT都是mri阳性FCD II和TSC引起的癫痫的有效治疗选择，在癫痫发作控制和安全性方面具有相当的疗效。术后癫痫发作结果不受患者年龄组的影响。
期刊介绍：
Seizure - European Journal of Epilepsy is an international journal owned by Epilepsy Action (the largest member led epilepsy organisation in the UK). It provides a forum for papers on all topics related to epilepsy and seizure disorders.
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