Neuropsychological outcomes comparing traditional surgical approaches and laser interstitial thermal therapy for refractory mesial temporal lobe epilepsy: A systematic review and meta-analysis.

OBJECTIVE

This systematic review and meta-analysis aimed to compare neuropsychological outcomes following traditional surgical approaches and magnetic resonance-guided laser interstitial thermal therapy (MRgLITT) in patients with drug-resistant mesial temporal lobe epilepsy.

METHODS

Thirty-four studies were included; 24 reported cognitive outcomes following open resection, seven following MRgLITT, and three reported on both procedures. Meta-analyses of proportions, subgroup comparisons, and meta-regressions were conducted across three cognitive domains: verbal memory, visual memory, and naming, stratified by surgical laterality and procedure type.

RESULTS

In left-sided surgery, verbal memory decline occurred in 36% (95% confidence interval [CI] = 28%-45%) after open resection and 29% (95% CI = 9%-62%) after MRgLITT, with no significant difference (p = .5967). For right-sided procedures, visual memory decline was similar between open resection (16%, 95% CI = 8%-29%) and MRgLITT (19%, 95% CI = 3%-61%; p = .8027). Left-sided naming decline was higher after open resection (43%, 95% CI = 27%-61%) than MRgLITT (9%, 95% CI = 3%-22%; p < .0001), a difference supported in subgroup and meta-regression analyses. Exploratory meta-regression suggested a borderline association between higher seizure freedom and greater naming decline (p = .0508), but MRgLITT retained a protective effect after adjusting for seizure outcomes (β = -1.36, 95% CI = -2.20 to -.51; p = .0016). Regardless of the approach, naming improvement occurred in 27% of patients in each group after right-sided surgery, indicating substantial recovery when the left hemisphere is preserved.

SIGNIFICANCE: Verbal memory showed a nonsignificant trend toward better preservation with MRgLITT, whereas visual memory was comparable across approaches. MRgLITT significantly preserved naming after left-sided surgery, offering a clear cognitive benefit over traditional open resection.