Seizure Outcomes After Resection of Temporal Encephalocele in Patients with Drug Resistant Epilepsy: A Systematic Review and Meta-analysis
Abstract number :
3.467
Submission category :
9. Surgery / 9C. All Ages
Year :
2024
Submission ID :
443
Source :
www.aesnet.org
Presentation date :
12/9/2024 12:00:00 AM
Published date :
Authors :
Presenting Author: Hamza Khoudari, MD – University of Debrecen
Mohammad Alabbas, MD – University of Debrecen
Benjamin Cox, MD – University of Alabama at Birmingham
Jorge Burneo, MD, MSPH, FAAN, FAES, FRCPC – Western University, London Ontario Canada
Steven Tobochnik, MD – Brigham and Women’s Hospital
Hernan Nicolas Lemus, MD – The University of Alabama at Birmingham
Rationale: Temporal encephaloceles (structural herniations of the brain parenchyma) are commonly seen in patients with drug resistant epilepsy (DRE). During the pre-surgical work-up of patients with DRE, temporal encephaloceles are lesions with a potential involvement in the epileptogenic network. However, temporal encephaloceles are prevalent in patients with idiopathic intracranial hypotension and no epileptogenicity. Thus, the relevance of temporal encephaloceles in epilepsy remains controversial with multiple sources of bias affecting current evidence. We sought to determine the rate and predictors of seizures outcomes after surgery in patients with DRE.
Methods: We searched Medline, Embase and Web of Science (between 1990 to April 2024) to identify studies reporting the outcomes of epilepsy surgery after 12 months in patients with DRE and temporal encephaloceles. The main outcome was seizure freedom or favorable seizure outcome (Engel Class I or International League Against Epilepsy class 1 or 2). We also assessed the rates of seizure freedom among patients with DRE and temporal encephaloceles and the following covariables: use of intracranial EEG during the presurgical work-up, side of the encephalocele, and type of surgical resection (anterior temporal lobectomy vs. lesionectomy). Random-effects meta-analysis was used to calculate the proportion of patients attaining seizure outcomes. Data processing and statistical analysis were performed using R 3.5.3 (R Foundation, Vienna, Austria).
Results: The literature review yielded a total of 331 studies. Of these, 17 studies (344 patients) met the criteria and were included in the meta-analysis. Most of the studies (12/17) reported both anterior temporal lobectomy and lesionectomy. The overall seizure freedom after 1 year of epilepsy surgery was 62% (95% confidence interval [CI] 51-71), while the overall favourable outcome rate 1 year after epilepsy surgery was 75% (95% CI 68-82). There was significant interstudy heterogeneity. There was no difference in the seizure freedom among the covariables. A power analysis revealed a sample size of 6559 patients necessary to demonstrate a marginally higher rate of seizure freedom after ATL (RR=0.94, 95%CI 0.68-1.30) compared to lesionectomy (alpha=0.05, beta=0.8).
Conclusions: Resection of temporal lobe encephaloceles in patients with DRE had similar outcomes as in temporal lobe epilepsy in general. ATL and lesionectomy have similar rates seizure freedom, with prohibitively large sample sizes required to demonstrate any difference between techniques. Future studies should focus on the biomarkers and biases for which ATL is preferred over more selective intervention.
Funding: No funding was received
Surgery