Magnetic Resonance-Guided Laser Interstitial Thermal Therapy in the Management of Hypothalamic Hamartomas: A Systematic Review and Meta-Analysis.

Autor: Ahmed S; Department of Medicine, Allama Iqbal Medical College, Lahore, Pakistan., Nadeem ZA; Department of Medicine, Allama Iqbal Medical College, Lahore, Pakistan., Kamran U; Department of Medicine, Allama Iqbal Medical College, Lahore, Pakistan., Ashfaq H; Department of Medicine, Allama Iqbal Medical College, Lahore, Pakistan., Ashraf H; Department of Cardiology, Allama Iqbal Medical College, Lahore, Pakistan., Ashraf M; Wolfson School of Medicine, University of Glasgow, Scotland, United Kingdom. Electronic address: Mohammad.ashraf@glasgow.ac.uk., Agarwal A; Department of Neurosurgery and Radiation Oncology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India., Farooq M; Department of Neurosurgery, King Edward Medical University, Mayo Hospital, Lahore, Pakistan.
Jazyk: angličtina
Zdroj: World neurosurgery [World Neurosurg] 2024 Oct; Vol. 190, pp. 463-469.e6. Date of Electronic Publication: 2024 Aug 08.
DOI: 10.1016/j.wneu.2024.08.009
Abstrakt: Objective: Magnetic resonance-guided laser interstitial thermal therapy (MRg-LITT) is a promising new technique to ablate epileptic foci in patients with hypothalamic hamartoma (HH). We aim to systematically synthesize all available evidence and determine the effectiveness of MRg-LITT in reducing seizures in patients with HH.
Methods: We systematically searched MEDLINE (PubMed), Embase (Ovid), Scopus, and Google Scholar for all relevant articles. We used Open[Meta]Analyst to pool the number of seizure-free patients after MRg-LITT treatment in a random-effects model. Risk ratios were calculated, and subgroups were analyzed. Comprehensive meta-analysis was used to assess publication bias via funnel plots, Egger's regression test, and Begg's correlation test. This review complies with the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines.
Results: After screening the titles, abstracts, and full texts, we included 17 articles in our meta-analysis, which revealed a 77.1% rate of seizure freedom (95% confidence interval 0.696-0.837, P<0.001), with moderate heterogeneity (I2=49.46%). Subgroup analysis by study design and sensitivity analyses excluding 1 study at a time did not impact the results substantially, and we found no evidence of publication bias. Adverse effects included electrolyte imbalances, weight gain, and transient neurologic disturbances.
Conclusions: MRg-LITT might be a feasible and effective technique for ablation of epileptic foci, leading to seizure freedom in a large proportion of patients with HH. However, there is a paucity of literature on the topic, and prospective clinical trials with larger number of participants comparing MRg-LITT to open surgery are needed.
(Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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