Endoscopic Epilepsy Surgery: Systematic Review and Meta-Analysis

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.