• Valerio Maria Caccavella, Martina Giordano, Gabriella Colicchio, Alessandro Izzo, Manuela D'Ercole, Alessandro Rapisarda, Filippo Maria Polli, Filomena Fuggetta, Alessandro Olivi, and Nicola Montano.
• Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy. Electronic address: valeriom.caccavella@gmail.com.
• World Neurosurg. 2022 Jul 1; 163: 132-140.e1.

BackgroundSeveral types of palliative surgery to treat drug-resistant epilepsy (DRE) have been reported, but the evidence that is available is insufficient to help physicians redirect patients with DRE to the most appropriate kind of surgery.MethodsA systematic search in the PubMed and Scopus databases was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to compare different clinical features, outcomes, and complications of adult patients submitted to callosotomy, vagal nerve stimulation, multiple subpial transections, deep brain stimulation, or responsive neurostimulation.ResultsAfter 3447 articles were screened, 36 studies were selected, including the data of 1628 patients: 76 were treated with callosotomy, 659 were treated with vagal nerve stimulation, 416 were treated with deep brain stimulation, and 477 were treated with responsive neurostimulation. No studies including patients treated with multiple subpial transections met the inclusion criteria. The global weighted average seizure frequency reduction was 50.23%, and the global responder rate was 52.12%. There were significant differences among the palliative surgical procedures in term of clinical features of patients and epilepsy, seizure frequency reduction, and percentage of responders. Complications were differently distributed as well.ConclusionsOur analysis highlights the necessity of prospective studies, possibly randomized controlled trials, to compare different forms of palliative epilepsy surgery. Moreover, by identifying the outcome predictors associated with each technique, the best responder may be profiled for each procedure.Copyright © 2022 Elsevier Inc. All rights reserved.

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