• Panagiotis Kerezoudis, Veronica Parisi, W Richard Marsh, Timothy J Kaufman, Vance T Lehman, Gregory A Worrell, Kai J Miller, and Jamie J Van Gompel.
• Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA. Electronic address: kerezoudis.panagiotis@mayo.edu.
• World Neurosurg. 2020 Nov 1; 143: 527-536.e3.

BackgroundLaser interstitial thermal therapy (LITT) has emerged as a safe and effective approach to the treatment of temporal lobe epilepsy (TLE). The relationship of ablation volume with postoperative outcomes remains an area of contention.MethodsWe conducted a systematic review and meta-analysis of available studies on LITT for TLE. Seizure freedom and complication rates were meta-analyzed using a random-effects model. Meta-regression of seizure freedom rate for the overall cohort and mesial temporal sclerosis (MTS) subset (n = 384) was performed adjusting for overall ablation volume as well as percentage of hippocampal and amygdala ablation.ResultsA total of 13 studies (551 patients) were analyzed. Pooled mean ablation volume was 5376 mm3 (range, 2900-7110 mm3), pooled mean hippocampal ablation was 67.5% (range, 56%-78.3%) and pooled mean amygdala ablation was 58.8% (range, 43%-73.7%). Overall seizure freedom rate was 58% (95% confidence interval [CI], 54%-62%) and was not significantly associated with total ablation volume (P = 0.42), hippocampal ablation (P = 0.67), or amygdala ablation (P = 0.33). Seizure freedom rate for patients with MTS was 66% (95% CI, 58%-74%) and was also not found to be significantly associated with total ablation volume (P = 0.15), hippocampal ablation (P = 0.73), or amygdala ablation (P = 0.43). Overall complication rate was 17% (95% CI, 13%-22%).ConclusionsThe findings show a pooled seizure freedom rate of 58% for all patients with TLE and 66% for patients with MTS undergoing LITT. The evidence is insufficient to support a significant relationship of seizure freedom rate with total ablation volume as well as hippocampal or amygdala ablation.Copyright © 2020 Elsevier Inc. All rights reserved.

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