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Laser Interstitial Thermal Therapy versus Open Surgery for Mesial Temporal Lobe Epilepsy: A Systematic Review and
Felix R Ekman1, Johan Bjellvi2, Sofia Ljunggren2
1Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
World Neurosurgery
|September 27, 2024
Summary
Temporal lobe resection (TLR) offers better seizure freedom for epilepsy than magnetic resonance-guided laser interstitial thermal therapy (MRgLITT), but with more transient complications. Visual field deficits and naming outcomes require further investigation for both epilepsy surgery options.
Area of Science:
- Neurosurgery
- Neurology
- Medical Technology
Background:
- Drug-resistant mesial temporal lobe epilepsy (MTLE) necessitates advanced surgical interventions.
- Temporal lobe resection (TLR) and magnetic resonance-guided laser interstitial thermal therapy (MRgLITT) are key surgical options for MTLE.
- Evaluating long-term outcomes and complications is crucial for clinical decision-making.
Purpose of the Study:
- To compare seizure freedom, visual field deficits, and complication rates between TLR and MRgLITT in MTLE patients at extended follow-up (>24 months).
- To analyze minor and major complication frequencies for both surgical techniques.
- To assess neurocognitive outcomes, specifically confrontation naming and verbal memory.
Main Methods:
- A meta-analysis was conducted on studies reporting seizure outcomes, visual field deficits, and complications following TLR and MRgLITT.
- Extended follow-up periods exceeding 24 months were prioritized for seizure outcome assessment.
- Complications were categorized as minor (<6 months) or major (>6 months) for detailed analysis.
Main Results:
- Temporal lobe resection (TLR) demonstrated superior seizure freedom rates (72.5%) compared to MRgLITT (57.1%) (P<0.01).
- Minor complications were significantly more frequent with TLR (9.9%) than MRgLITT (4.1%) (P=0.04).
- MRgLITT showed a more favorable outcome in confrontation naming, while verbal memory data remains inconclusive.
Conclusions:
- TLR is more effective for achieving seizure freedom in drug-resistant MTLE but is associated with a higher risk of transient complications.
- While not statistically significant, a trend towards more visual field deficits was observed with TLR.
- MRgLITT presents a viable alternative with fewer minor complications and better naming outcomes, though further research on verbal memory is warranted.
