Surgical Outcomes of Laser Interstitial Thermal Therapy for Temporal Lobe Epilepsy: Systematic Review and Meta-analysis

Panagiotis Kerezoudis, Veronica Parisi, W. Richard Marsh, Timothy J. Kaufman, Vance T. Lehman, Gregory A. Worrell, Kai J. Miller, Jamie J. Van Gompel

Research output: Contribution to journalReview articlepeer-review

3 Scopus citations

Abstract

Background: Laser interstitial thermal therapy (LITT) has emerged as a safe and effective approach to the treatment of temporal lobe epilepsy (TLE). The relationship of ablation volume with postoperative outcomes remains an area of contention. Methods: We conducted a systematic review and meta-analysis of available studies on LITT for TLE. Seizure freedom and complication rates were meta-analyzed using a random-effects model. Meta-regression of seizure freedom rate for the overall cohort and mesial temporal sclerosis (MTS) subset (n = 384) was performed adjusting for overall ablation volume as well as percentage of hippocampal and amygdala ablation. Results: A total of 13 studies (551 patients) were analyzed. Pooled mean ablation volume was 5376 mm3 (range, 2900–7110 mm3), pooled mean hippocampal ablation was 67.5% (range, 56%–78.3%) and pooled mean amygdala ablation was 58.8% (range, 43%–73.7%). Overall seizure freedom rate was 58% (95% confidence interval [CI], 54%–62%) and was not significantly associated with total ablation volume (P = 0.42), hippocampal ablation (P = 0.67), or amygdala ablation (P = 0.33). Seizure freedom rate for patients with MTS was 66% (95% CI, 58%–74%) and was also not found to be significantly associated with total ablation volume (P = 0.15), hippocampal ablation (P = 0.73), or amygdala ablation (P = 0.43). Overall complication rate was 17% (95% CI, 13%–22%). Conclusions: The findings show a pooled seizure freedom rate of 58% for all patients with TLE and 66% for patients with MTS undergoing LITT. The evidence is insufficient to support a significant relationship of seizure freedom rate with total ablation volume as well as hippocampal or amygdala ablation.

Original languageEnglish (US)
Pages (from-to)527-536.e3
JournalWorld neurosurgery
Volume143
DOIs
StatePublished - Nov 2020

Keywords

  • Amygdala
  • Epilepsy surgery
  • Hippocampus
  • Mesial temporal sclerosis
  • Meta-analysis
  • Seizure freedom
  • Systematic review

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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