Magnetic resonance-guided laser interstitial thermal therapy vs. open surgery for drug-resistant mesial temporal lobe epilepsy: a propensity score matched retrospective cohort study

被引:5
作者
Mo, Jiajie [1 ,3 ]
Guo, Zhihao [1 ,3 ]
Wang, Xiu [1 ,3 ]
Zhang, Jianguo [1 ,3 ]
Hu, Wenhan [1 ,3 ]
Shao, Xiaoqiu [2 ,4 ]
Sang, Lin [5 ]
Zheng, Zhong [5 ]
Zhang, Chao [1 ,3 ]
Zhang, Kai [1 ,3 ]
机构
[1] Beijing Tiantan Hosp, Dept Neurosurg, Beijing, Peoples R China
[2] Beijing Tiantan Hosp, Dept Neurol, Beijing, Peoples R China
[3] Capital Med Univ, Beijing Neurosurg Inst, Dept Neurosurg, 119 South 4th Ring West Rd, Beijing 100070, Peoples R China
[4] China Natl Clin Res Ctr Neurol Dis NCRC ND, Beijing, Peoples R China
[5] Beijing Fengtai Hosp, Dept Neurosurg, Beijing, Peoples R China
基金
中国国家自然科学基金; 国家重点研发计划;
关键词
drug-resistant mesial temporal lobe epilepsy; magnetic resonance-guided laser interstitial thermal therapy; open surgery; propensity score matching; FOCAL CORTICAL DYSPLASIA; ABLATION;
D O I
10.1097/JS9.0000000000000811
中图分类号
R61 [外科手术学];
学科分类号
摘要
Background: Magnetic resonance-guided laser interstitial thermal therapy (MRgLITT) and traditional open surgery (OS) are effective and safe options for patients with drug-resistant mesial temporal lobe epilepsy (DR-mTLE). However, their superiority in seizure control and preservation of functional abilities remains unclear. This study aimed to compare the surgical outcomes of MRgLITT and OS. Materials and methods: This multicenter retrospective cohort study included patients with DR-mTLE who underwent MRgLITT or OS at three centres between 2015 and 2023. The data on patient demographics, presurgical non-invasive evaluation, stereoelectroencephalography (SEEG) implantation, memory alteration, and seizure outcomes were collected. Propensity score matching (PSM) analysis was conducted for the comparison of seizure control and functional preservation between two surgical approaches. Results: Of the 244 individuals who met the study criteria, 33 underwent MRgLITT and 211 OS. The median (interquartile range) age at seizure onset was 22.0 (13.0) and 12.3 (10.0) years in the MRgLITT and OS groups, respectively. The first PSM, based on demographic and non-invasive information, resulted in 26 matched pairs for the primary analysis. There were no significant differences in memory preservation (P = 0.95) or surgical outcomes (P = 0.96) between the groups. The second PSM, based on demographics and SEEG implantation, yielded 32 matched pairs for the sensitivity analysis, showing similar results. Subset analysis of early and late MRgLITT cases revealed no statistically significant differences in the proportion of patients with memory decline (P = 0.42) or seizure control (P = 1.00). Patients who underwent SEEG implantation were 96% less likely to achieve seizure freedom after MRgLITT (P = 0.02). Conclusion: Minimally invasive MRgLITT is associated with memory preservation and seizure control, similar to traditional OS. MRgLITT is effective and safe for DR-mTLE and is relevant for future prospective randomized trials on dominant-side mTLE, providing practical implications for guiding neurosurgeons in the selection of surgical approaches.
引用
收藏
页码:306 / 314
页数:9
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