Porównanie selektywnej operacji amigdalo-hipokampalnej i przedniej lobektomii skroniowej w leczeniu opornej na leki epilepsji skroniowej: przegląd systematyczny i metaanaliza
Comparison of selective amygdalohippocampectomy and anterior temporal lobectomy for mesial temporal lobe epilepsy: a systematic review and meta-analysis
W skrócie
Badanie porównało dwie główne metody chirurgiczne leczenia epilepsji skroniowej, która nie poddaje się lekom: przednia lobektomia skroniowa i bardziej ograniczona operacja amigdalo-hipokampalna. Wyniki pokazują, że przednia lobektomia skuteczniej wstrzymuje napady, ale operacja bardziej ograniczona ma lepsze wyniki w kwestii zaburzeń wzroku i powikłań pooperacyjnych. Wybór metody powinien być dostosowany do indywidualnych warunków każdego pacjenta, biorąc pod uwagę zarówno kontrolę napadów, jak i możliwe powikłania.
Oryginalny abstract (angielski)
BACKGROUND: Anterior temporal lobectomy (ATL) and selective amygdalohippocampectomy (SAH) are the two most widely adopted surgical approaches for drug-resistant mesial temporal lobe epilepsy (MTLE). Although both procedures target seizure control, they differ in extent of resection and potential morbidity. The relative effectiveness of ATL and SAH remains debated, particularly regarding seizure freedom, visual field deficits, and postoperative complications. OBJECTIVE: To systematically compare seizure freedom (Engel I) rates, Engel III-IV outcomes, visual field deficits, and postoperative complications between ATL and SAH. METHODS: A systematic review and -analysis were performed according to PRISMA guidelines. Searches included PubMed, Embase, Web of Science, and Scopus (1996-2023). Statistical analyses were conducted using R (version 4.3.2) with the and packages. Random-effects or fixed-effects models were applied based on heterogeneity. Risk of bias was assessed using ROBINS-I V2. Twenty-two studies were included, totaling 2,482 patients. RESULTS: • SAH demonstrated an of postoperative seizure freedom compared with ATL (RR = 0.92, 95% CI 0.87-0.97; = 0.05; I = 32%).• SAH showed a toward higher risk of poor seizure control (RR = 1.22, 95% CI 1.00-1.50; > 0.05; I = 28%).• SAH was associated with a (RR = 0.62, 95% CI 0.47-0.83; < 0.05; I = 32%).• SAH resulted in a of visual field defects (RR = 0.85, 95% CI 0.73-0.99; < 0.05). CONCLUSIONS: ATL provides superior seizure control compared to SAH, whereas SAH offers measurable advantages in visual and perioperative morbidity. The nonsignificant trend toward poorer seizure outcomes in SAH highlights the importance of patient selection and anatomical considerations. These findings support individualized surgical decision-making for drug-resistant MTLE, balancing seizure freedom against visual and postoperative risks.