Comparison of minimally invasive and traditional surgical approaches for refractory mesial temporal lobe epilepsy: A systematic review and meta?analysis of outcomes

Magnetic resonance-guided laser interstitial therapy (MRgLITT) and radiofrequency ablation (RFA) represent two minimally invasive methods for the treatment of drug-refractory mesial temporal lobe epilepsy (mTLE). We performed a systematic review meta-analysis to compare outcomes complications between MRgLITT, RFA, conventional surgical approaches (i.e., anterior resection [ATL] or selective amygdalohippocampectomy [sAHE]). Forty-three studies (13 6 24 surgery studies) involved 554, 123, 1504, 1326 patients treated by ATL, sAHE, respectively. Engel Class I (Engel-I) were achieved after MRgLITT in 57% (315/554, range = 33.3%-67.4%), RFA 44% (54/123, 0%-67.2%), ATL 69% (1032/1504, 40%-92.9%), sAHE 66% (887/1326, 21.4%-93.3%). Meta-analysis revealed no significant difference seizure outcome (Q 2.74, p .098), whereas both superior (ATL: Q 8.92, .002; sAHE: 4.33, .037) 6.42, .0113; 5.04, .0247), with better at follow-up 60 months more. Mesial hippocampal sclerosis (mTLE + sclerosis) was associated significantly (Engel-I 64%; 8.55, .0035). The rate major 3.8% 3.7% 10.9% 7.4% sAHE; differences did not show statistical significance. Neuropsychological deficits occurred all procedures, left-sided surgeries having higher verbal memory impairment. Lateral functions such as naming object recognition may be more preserved MRgLITT. Thermal therapies are effective techniques but lower Engel-I comparison sAHE. Between there outcome, whereby success seems depend on approach used (e.g., occipital approach). shows similar compared undergoing experience fewer might have beneficial neuropsychological outcome.