Laser interstitial thermal therapy versus open surgery for mesial temporal lobe epilepsy: A systematic review and meta-analysis.

Epilepsy surgery offers a vital treatment option for drug-resistant mesial temporal lobe epilepsy (mTLE), with Temporal Lobe Resection (TLR) and Magnetic Resonance-guided Laser Interstitial Thermal Therapy (MRgLITT) being fundamental interventions. This meta-analysis specifically examines seizure outcomes at extended follow-up periods exceeding 24 months, visual field deficits as measured by perimetry, and complication rates both overall and categorized based on duration as minor (transient <6 months) or major (persistent >6 months) to inform clinical decision-making. For seizure freedom, TLR was superior, with 72.5% [65.6%, 78.5%] of patients achieving postoperative seizure freedom compared to 57.1% [51.2%, 62.7%] for MRgLITT (P-value <0.01). Visual field deficits were observed in 79.4% [59.5%, 91.0%] of TLR patients and 49.8% [23.6%, 76.0%] of MRgLITT patients, a difference not reaching statistical significance (P-value: 0.08). Overall complication rates were 11.4% [7.4%, 17.2%] for TLR and 6.5% [3.3%, 12.3%] for MRgLITT (P-value 0.15). Major complications occurred in 2.0% [1.1%, 3.09%] of TLR cases and 2.7% [1.4%, 5.2%] of MRgLITT cases (P-value 0.54), while minor complications were significantly more frequent with TLR at 9.9% [6.4%, 15.0%] versus MRgLITT's 4.1% [1.9%, 8.4%] (P-value 0.04). MRgLITT had a more favorable outcome regarding confrontation naming while more studies are needed regarding verbal memory to be able to draw firm conclusions. TLR provides superior seizure freedom but comes with an increased risk of transient complications. Although there was no statistical significance in visual field deficits, the trend suggests a higher frequency with TLR. The study's extensive data analysis, including rigorous sensitivity checks, ensures the robustness of these conclusions, reflecting a comprehensive analysis of the available data at this time point.

Strengths and limitations of tractography methods to identify the optic radiation for epilepsy surgery.

Diffusion tensor imaging (DTI) tractography (TG) can visualize Meyer's loop (ML), providing important information for the epilepsy surgery team, both for preoperative counseling and to reduce the frequency of visual field defects after temporal lobe resection (TLR). This review highlights significant steps in the TG process, specifically the processing of raw data including choice of TG algorithm and the interpretation and validation of results. A lack of standardization of TG of the optic radiation makes study comparisons challenging. We discuss results showing differences between studies and uncertainties large enough to be of clinical relevance and present implications of this technique for temporal lobe epilepsy surgery. Recent studies in temporal lobe epilepsy patients, employing TG intraoperatively, show promising results in reduction of visual field defects, with maintained seizure reduction.