目的:本系统综述和荟萃分析的目的是提供对研究结果的最新分析,发病率,与MR引导激光间质热疗(MRgLITT)call体消融(CCA)相关的死亡率。
方法:筛选的研究纳入标准要求研究报告仅针对人类受试者,包括1-52岁被诊断为耐药癫痫并接受CCA的患者.2016年至2023年发表的16篇文章被纳入系统回顾和分析,包括4例病例报告,11个案例系列,1项病例对照研究。总之,85例接受CCA的儿童和成人患者纳入系统评价(46例年轻患者和39例21岁以上患者)。癫痫发作自由的主要结果是使用手术后失速性癫痫发作频率的降低来测量的,手术后无张力癫痫发作的比例,以及手术后总体癫痫发作自由的百分比。这些测量是使用来自CCA后至少6个月随访的患者的最后一次随访的数据进行的。
结果:合并队列的CCA程度不同,包括前三分之二CCA(38.89%,n=35)和完成先前部分CCA的后三分之一CCA(22.22%,n=20),完整的CCA(27.78%,n=25),或在次全初始消融的情况下残留白质的CCA(5.56%,n=5)。总的来说,接受CCA的患者中有12.94%出现手术并发症。90例CCA手术中最常见的手术并发症是探头错位(n=6),出血(n=5),脾消融向丘脑的脱靶延伸(n=1),感染(n=1),术后脑脊液漏(n=1)。在所有研究中,CCA后的神经功能缺损在18.82%的患者中被报道为一过性的,在4.71%的患者中被报道为永久性的。最常见的神经功能缺损是断开综合征(n=4)或短暂性偏瘫(补充运动区样综合征;n=4)。53例患者的6个月总体癫痫发作自由率为18.87%,52例患者术后无张力发作的发生率为46.28%。CCA导致失稳性癫痫发作率平均从每天8.30下降至1.65(平均下降80.12%)。
结论:CCA与可接受的并发症有关,大多数患者的目标癫痫发作症状有意义地减少。准确的MRgLITT探针放置对于最大化CCA同时避免附带损害可能很重要。CCA可避免的并发症包括脱靶消融(和相关缺陷),出血,以及未来的残余CCA手术以减轻持续的癫痫发作。
OBJECTIVE: The goal of this systematic
review and meta-analysis was to provide an updated analysis of studies investigating outcomes, morbidity, and mortality associated with MR-guided laser interstitial thermal therapy (MRgLITT) corpus callosum ablation (CCA).
METHODS: Study inclusion criteria for screening required that studies report on human subjects only, including patients aged 1-52 years diagnosed with drug-resistant epilepsy who underwent CCA. Sixteen articles published between 2016 and 2023 were included for the systematic
review and analysis, including 4 case reports, 11 case series, and 1 case-control study. Altogether, 85 pediatric and adult patients undergoing CCA were included in the systematic
review (46 patients younger and 39 patients older than 21 years). The main outcome of seizure freedom was measured using the decrease in the frequency of atonic seizures following surgery, percentage of atonic seizure freedom following surgery, and percentage of overall seizure freedom following surgery. These measurements were made using data from the last follow-up for patients with at least 6 months of follow-up post-CCA.
RESULTS: The extent of CCA differed across the pooled cohorts, including anterior two-thirds CCA (38.89%, n = 35) and posterior one-third CCA for completion of a prior partial CCA (22.22%, n = 20), complete CCA (27.78%, n = 25), or CCA of residual white matter in the case of subtotal initial ablation (5.56%, n = 5). Overall, 12.94% of the patients undergoing CCA experienced operational complications. The most common operative complications across 90 CCA operations were probe malpositioning (n = 6), hemorrhage (n = 5), off-target extension of splenium ablation to the thalamus (n = 1), infection (n = 1), and postoperative CSF leak (n = 1). Neurological deficits following CCA were reported as transient in 18.82% and permanent in 4.71% of patients across all studies. The most common neurological deficits were disconnection syndrome (n = 4) or transient hemiplegia (supplementary motor area-like syndrome; n = 4). The 6-month overall seizure freedom rate was 18.87% of 53 patients, and the atonic seizure freedom rate was 46.28% of 52 patients postoperatively. CCA resulted in an average decrease in atonic seizure rate from 8.30 to 1.65 atonic seizures per day (average decrease 80.12%).
CONCLUSIONS: CCA is associated with an acceptable complication profile, and most patients experience a meaningful reduction in target seizure semiologies. Accurate MRgLITT probe placement is likely important for maximizing CCA while avoiding collateral damage. Avoidable complications of CCA include off-target ablation (and associated deficits), hemorrhage, and future surgery for residual CCA to palliate continued seizures.