Magnetic resonance‐guided laser interstitial thermal therapy fordrug‐resistantepilepsy: A systematic review and individual participant datameta‐analysis

Abstract

Magnetic resonance‐guided laser interstitial thermal therapy (MRgLITT) has emerged as a popular minimally invasive alternative to open resective surgery for drug‐resistant epilepsy (DRE). We sought to perform a systematic review and individual participant data meta‐analysis to identify independent predictors of seizure outcome and complications following MRgLITT for DRE. Eleven databases were searched from January 1, 2010 to February 6, 2021 using the terms “MR‐guided ablation therapy” and “epilepsy”. Multivariable mixed‐effects Cox and logistic regression identified predictors of time to seizure recurrence, seizure freedom, operative complications, and postoperative neurological deficits. From 8705 citations, 46 studies reporting on 450 MRgLITT DRE patients (mean age = 29.5 ± 18.1 years, 49.6% female) were included. Median postoperative seizure freedom and follow‐up duration were 15.5 and 19.0 months, respectively. Overall, 240 (57.8%) of 415 patients (excluding palliative corpus callosotomy) were seizure‐free at last follow‐up. Generalized seizure semiology (hazard ratio [HR] = 1.78, p = .020) and nonlesional magnetic resonance imaging (MRI) findings (HR = 1.50, p = .032) independently predicted shorter time to seizure recurrence. Cerebral cavernous malformation (CCM; odds ratio [OR] = 7.97, p < .001) and mesial temporal sclerosis/atrophy (MTS/A; OR = 2.21, p = .011) were independently associated with greater odds of seizure freedom at last follow‐up. Operative complications occurred in 28 (8.5%) of 330 patients and were independently associated with extratemporal ablations (OR = 5.40, p = .012) and nonlesional MRI studies (OR = 3.25, p = .017). Postoperative neurological deficits were observed in 53 (15.1%) of 352 patients and were independently predicted by hypothalamic hamartoma etiology (OR = 5.93, p = .006) and invasive electroencephalographic monitoring (OR = 4.83, p = .003). Overall, MRgLITT is particularly effective in treating patients with well‐circumscribed lesional DRE, such as CCM and MTS/A, but less effective in nonlesional cases or lesional cases with a more diffuse epileptogenic network associated with generalized seizures. This study identifies independent predictors of seizure freedom and complications following MRgLITT that may help further guide patient selection.

Laser interstitial thermal therapy of a single nodule in a complex epileptic network with multiple periventricular nodular heterotopias

“…Laser interstitial thermal therapy is a minimally invasive stereotactic alternative to open resection in patients with drug-resistant epilepsy. 1 This surgical approach causes ablation of brain lesions using laser thermal energy under real-time MR thermography. 1 Surgical series in the past 10 years have shown its safety and efficacy for treating deep-seated lesions and lesions within or near eloquent regions.…”

“… 1 This surgical approach causes ablation of brain lesions using laser thermal energy under real-time MR thermography. 1 Surgical series in the past 10 years have shown its safety and efficacy for treating deep-seated lesions and lesions within or near eloquent regions. 1 LITT has been shown particularly effective to treat epileptogenic lesions such as mesial temporal sclerosis, hypothalamic hamartomas, malformations of cortical development, and cavernomas, leading to good or excellent seizure control rates.…”