Laser Interstitial Thermal Therapy for Treatment of Drug-Resistant Epilepsy: A Systematic

OBJECTIVE: Robotic-assisted laser interstitial thermal therapy (LITT) is a minimally invasive method for ablating seizure foci and has gained prominence in epilepsy treatment. The use of robotic guidance in these procedures can minimize errors in probe placement, potentially leading to better clinical outcomes. In this meta-analysis, we assessed the accuracy, safety, and effectiveness of robot-assisted LITT for drug-resistant epilepsy. METHODS: A systematic search was conducted in Scopus, Web of Science, PubMed, and Embase till July 7th, 2024. Two independent authors performed screening and data extraction. Random-effect meta-analysis was performed to determine the accuracy, procedure duration, efficacy, and complications of robot-assisted LITT. RESULTS: Overall, 11 studies were included in the meta-analyses. The results demonstrated that the overall target point localization error was 1.66 (95% confidence interval [CI] = 1.23-2.25) with higher precision in frame-based methods (P = 0.02). The mean procedure duration was 5.35 hours (95% CI = 3.69-7.74), and the pooled ablation time was 11.24 minutes (95% CI = 2.78-45.49); both were longer in disconnection surgery compared to the ablative procedure (P < 0.001 and P < 0.0001, respectively). In follow-up, 0.58 (95% CI = 0.47-0.69) of patients became seizure-free, and 0.86 (95% CI = 0.72- 0.95) of patients had improvements. Individual patient data analysis showed that robots in LITT are usually used when there are more lesions (P< 0.01). CONCLUSIONS: Robot-assisted LITT offers high precision, positive seizure outcomes, and minimal complications, comparable to nonrobotic methods, and is suitable for treating drug-resistant epilepsy with multiple lesions.