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

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Title: Neuropsychological outcomes comparing traditional surgical approaches and laser interstitial thermal therapy for refractory mesial temporal lobe epilepsy: A systematic review and meta‐analysis.
Authors: Stavrogianni, Konstantina (AUTHOR), Poprelka, Katerina (AUTHOR), Fasilis, Theodoros (AUTHOR), Giannopapas, Vasileios (AUTHOR), Hahn, Wiebke (AUTHOR), Gorny, Iris (AUTHOR), Kalyvas, Aristotelis (AUTHOR), Stavrinou, Lampis (AUTHOR), Giannopoulos, Sotirios (AUTHOR), Boviatsis, Efstathios (AUTHOR), Tsivgoulis, Georgios (AUTHOR), Bonakis, Anastasios (AUTHOR), Knake, Susanne (AUTHOR), Tsalouchidou, Panagiota‐Eleni (AUTHOR)
Source: Epilepsia (Series 4). Feb2026, Vol. 67 Issue 2, p588-605. 18p.
Subjects: Laser surgery, Temporal lobe epilepsy, Visual memory, Verbal memory, Cognitive ability, Cognition disorders, Operative surgery
Abstract: 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. [ABSTRACT FROM AUTHOR]
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Database: Psychology and Behavioral Sciences Collection
Description
Abstract: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. [ABSTRACT FROM AUTHOR]
ISSN:00139580
DOI:10.1111/epi.18687