Yuxin Wang, Yuchen Tai, Tinghong Liu, Shuli Liang
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.
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.