BACKGROUND AND OBJECTIVES There is a paucity of data directly comparing the outcome of surgical techniques available for the treatment of hypothalamic hamartomas (HHs). This study aims to evaluate the safety and efficacy of commonly used surgical approaches in the treatment of HH-related epilepsy. METHODS A systematic review and individual participant data (IPD) meta-analysis was conducted. The PubMed, Embase, and Scopus online databases were searched without any date restrictions for original studies with more than 1 participant reporting on patients with HH-related epilepsy who underwent surgical treatment. Random-effects modeling was used to calculate the pooled proportions of seizure freedom (Engel I) at the last follow-up. IPD were used to perform mixed-effects logistic regression to identify predictors of seizure freedom and major postoperative complications. RESULTS Sixty-four studies were included, and IPD on 517 patients were obtained. The overall quality of evidence was low. After the index procedure, the pooled proportion of overall seizure freedom was 50.0% (95% CI 42.7%-57.4%), which increased to 64.5% (95% CI 57.2%-71.5%) after multiple treatments. Magnetic resonance-guided laser interstitial thermal therapy (MRgLITT) and radiofrequency thermocoagulation (RFTC) demonstrated the highest efficacy at the last follow-up, with seizure freedom rates of 74.5% (95% CI 66.8%-81.7%) and 78.5% (95% CI 71.6%-84.8%), respectively. Factors independently associated with a lower likelihood of seizure freedom included multiple seizure types (odds ratio [OR] 0.296, 95% CI 0.140-0.624, p = 0.001) and previous surgery (OR 0.418, 95% CI 0.198-0.884, p = 0.023). Stereotactic radiosurgery (SRS) was the safest approach, with a pooled proportion of major complications of 0.0% (95% CI 0.0%-1.4%). Only surgical technique emerged as an independent predictor of major complications, with SRS (OR 0.024, 95% CI 0.002-0.292, p = 0.004), RFTC (OR 0.133, 95% CI 0.026-0.692, p = 0.017), and MRgLITT (OR 0.234, 95% CI 0.056-0.968, p = 0.045) being associated with a lower likelihood of major complications. DISCUSSION MRgLITT and RFTC offer superior efficacy and safety compared with open microsurgery and should be considered as first-line options. Despite its lower efficacy, SRS is associated with few reported long-term complications, making it a viable alternative for select cases, such as small HHs with good baseline functioning. Direct comparisons between techniques are limited by short follow-up durations in RFTC and MRgLITT cohorts. Further large-scale, multicenter studies directly comparing these modalities are warranted.

中文翻译：

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下丘脑错构瘤相关癫痫手术结果：系统评价和个体参与者数据荟萃分析。


背景和目标 缺乏直接比较可用于治疗下丘脑错构瘤 （HHs） 的手术技术结果的数据。本研究旨在评估常用手术方法治疗 HH 相关癫痫的安全性和有效性。方法 进行了系统评价和个体参与者数据 （IPD） 荟萃分析。对 PubMed、Embase 和 Scopus 在线数据库进行检索，没有任何日期限制的原始研究，其中超过 1 名参与者报告了接受手术治疗的 HH 相关癫痫患者。随机效应模型用于计算最后一次随访时无癫痫发作的合并比例 （Engel I）。IPD 用于进行混合效应 logistic 回归，以确定无癫痫发作和主要术后并发症的预测因子。结果 共纳入 64 项研究，获得 517 例患者的 IPD。总体证据质量低。指数程序后，总体无癫痫发作的合并比例为 50.0% （95% CI 42.7%-57.4%），多次治疗后增加到 64.5% （95% CI 57.2%-71.5%）。磁共振引导下激光间质热疗 （MRgLITT） 和射频热凝法 （RFTC） 在最后一次随访中显示出最高的疗效，癫痫发作自由率分别为 74.5% （95% CI 66.8%-81.7%） 和 78.5% （95% CI 71.6%-84.8%）。与无癫痫发作可能性独立相关的因素包括多种癫痫发作类型 （比值比 [OR] 0.296,95% CI 0.140-0.624，p = 0.001）和既往手术 （OR 0.418,95% CI 0.198-0.884，p = 0.023）。立体定向放射外科 （SRS） 是最安全的方法，主要并发症的合并比例为 0。0% （95% CI 0.0%-1.4%）。只有手术技术成为主要并发症的独立预测因子，其中 SRS （OR 0.024,95% CI 0.002-0.292，p = 0.004）、RFTC （OR 0.133,95% CI 0.026-0.692，p = 0.017） 和 MRgLITT （OR 0.234,95% CI 0.056-0.968，p = 0.045） 与主要并发症的可能性较低相关。讨论与开放显微外科手术相比，MRgLITT 和 RFTC 具有更好的疗效和安全性，应考虑作为一线治疗选择。尽管 SRS 的疗效较低，但很少报道长期并发症，使其成为特定病例的可行替代方案，例如基线功能良好的小型 HH。在 RFTC 和 MRgLITT 队列中，技术之间的直接比较受到较短随访时间的限制。有必要进一步进行大规模、多中心研究，直接比较这些方式。