Efficacy and safety of laser interstitial thermal therapy versus radiofrequency ablation and stereotactic radiosurgery in the treatment of intractable mesial temporal lobe epilepsy: a systematic review and meta-analysis.

Epilepsy is a common neurological disease that is treated with medications; however, patients with drug-resistant epilepsy, commonly intractable temporal lobe epilepsy, tend to have better control with surgical treatment. While the mainstay of surgical treatment is anterior temporal lobectomy, it carries risk of potential adverse effects hence minimally invasive techniques are now being used as an alternative to open surgery. This systematic review and meta-analysis compare the efficacy and safety of three of the most used techniques: laser interstitial thermal therapy (LITT), radiofrequency ablation (RFA) and stereotactic radiosurgery (SRS). Multiple databases were searched and PRISMA guidelines were followed to make an indirect meta-analysis using the currently available studies for the three techniques in terms of seizure freedom, risk of major complications and reoperations. Further subgroup analyses were carried out for LITT in terms of follow up periods and seizure freedom in patients with or without hippocampal sclerosis. A total of 42 papers were included in this study with a total of 1675 patients (1303 treated by LITT, 188 treated by RFA and 184 treated by SRS). LITT had the highest rate of seizure freedom (55.0%, CI 51.5 - 58.5%, P = 0.148), and the lowest rates of major complications (2.3%, CI 1.2 - 3.5%, P = 0.070), and reoperations (14.3%, CI 10.4 - 18.3%, P = 0.042) compared to RFA and SRS which had seizure freedom of 46.3% (CI 18.8 - 73.7%, P = 0.000) and 53.8% (CI 44.4 - 63.3%; I^2 = 40.4%, P = 0.098), major complication rate of 3.9% (CI 0.7 - 7.0%; I^2 = 0%, P = 0.458) and 14.3% (CI 3.1 - 25.5%, P = 0.000) and reoperation rate of 28.6% (CI -4.3 - 61.5%, P = 0.000) and 15.4% (CI 6.1 - 24.8%; I^2 = 0%, P = 0.392) respectively. In conclusion, LITT showed the highest rate of seizure freedom and the lowest rate of major complications and reoperations compared to RFA and SRS in single-arm studies of intractable mesial temporal lobe epilepsy. However, the lack of direct comparisons between treatment modalities limits definitive conclusions. Despite this, LITT appears to offer a favorable safety profile, warranting further prospective, comparative studies to validate these findings.