RESUMO
PURPOSE: Resective epilepsy surgery based on an invasive EEG-monitors performed with subdural grids (SDG) or depth electrodes (stereo-electroencephalography, SEEG) is considered to be the best option towards achieving seizure-free state in drug-resistant epilepsy. The authors present a meta-analysis, due to the lack of such a study focusing on surgical outcomes originating from SDG- or SEEG-monitors. METHOD: English-language studies published until May 2018, highlighting surgical outcomes were reviewed. Outcome measures including total number of SDG- or SEEG-monitors and resective surgeries; consecutively followed surgical cases; surgical outcomes classified by Engel in overall, temporal/extratemporal and lesional/nonlesional subgroups were analyzed. RESULTS: 19 articles containing 1025 SDG-interventions and 16 publications comprising 974 SEEG-monitors were researched. The rate of resective surgery deriving from SDG-monitoring hovered at 88.8% (95%CI:83.3-92.6%) (I2â¯=â¯77.0%;pâ¯<â¯0.001); in SEEG-group, 79.0% (95%CI:70.4-85.7%) (I2â¯=â¯72.5%;pâ¯<â¯0.001) was measured. After SDG-interventions, percentage of post-resective follow-up escalated to 96.0% (95%CI:92.0-98.1%) (I2â¯=â¯49.1%;pâ¯=â¯0.010), and in SEEG-group, it reached 94.9% (95%CI:89.3-97.6%) (I2â¯=â¯80.2%;pâ¯<â¯0.001). In SDG-group, ratio of seizure-free outcomes reached 55.9% (95%CI:50.9-60.8%) (I2â¯=â¯54.47%;pâ¯=â¯0.002). Using SEEG-monitor, seizure-freedom occurred in 64.7% (95%CI:59.2-69.8%) (I2â¯=â¯11.9%;pâ¯=â¯0.32). Assessing lesional cases, likelihood of Engel I outcome was found in 57.3% (95%CI:48.7%-65.6%) (I2â¯=â¯69.9%;pâ¯<â¯0.001), using SDG; while in SEEG-group, it was 71.6% (95%CI:61.6%-79.9%) (I2â¯=â¯24.5%;pâ¯=â¯0.225). In temporal subgroup, ratio of seizure-freedom was found to be 56.7% (95%CI:51.5%-61.9%) (I2â¯=â¯3.2%;pâ¯=â¯0.412) in SDG-group; whereas, SEEG-group reached 73.9% (95%CI:64.4%-81.6%); (I2â¯=â¯0.00%;pâ¯=â¯0.45). Significant differences between seizure-free outcomes were found in overall (pâ¯=â¯0.02), lesional (pâ¯=â¯0.031), and also, temporal (pâ¯=â¯0.002) comparisons. CONCLUSIONS: SEEG-interventions were associated, at least, non-inferiorly, with seizure-freedom compared with SDG-monitors in temporal, lesional and overall subgroups.