Minimally invasive surgery safer but less effective than open surgery in children with DRE

In the treatment of children with drug-resistant epilepsy (DRE), minimally invasive magnetic resonance-guided laser interstitial thermal therapy (MRgLITT) is associated with lower rate of seizure freedom at 1 year but has the advantage of lower complication rates and shorter hospitalization as compared with open surgery, as shown in a study.

The retrospective multicentre cohort study included 185 children with DRE treated with MRgLITT and 185 matched children who underwent open surgery. All patients had 1-year follow-up data. None of them had corpus callosotomy, neurostimulation, multilobar or hemispheric surgery, and lesion with maximal dimension >60 mm.

The primary outcome of seizure freedom at 1 year post-treatment was achieved by fewer patients in the MRgLITT group than in the open surgery group (48.1 percent vs 61.6 percent; difference, −13.5 percent, one-sided 97.5 percent confidence interval, −23.8 percent to ∞; p_{noninferiority}=0.79). The lower confidence interval boundary of −23.8 percent did not meet the prespecified noninferiority margin of −10 percent.

However, MRgLITT was associated with lower overall complications (10.8 percent vs 29.2 percent; p<0.001) and shorter hospitalization relative to open surgery (3.1 vs 7.2 days; p<0.001).

The present data indicate that while MRgLITT has a more favourable safety profile, it is inferior to open surgery in terms of seizure outcomes. This should help counsel children and parents on the benefits and risks of treatments, as well as contribute to informed decision-making.