1290 Differences in Safety and Seizure Outcomes Between Laser Interstitial Thermal Therapy and Open Surgery for Drug Resistant Epilepsy: A Meta-Analysis of 6267 Patient Data

INTRODUCTION: Open Surgery (OS) has become the standard of care for Drug Resistant Epilepsy (DRE). Similiarly, Laser Interstitial Thermal Therapy (LITT) has emerged as a minimally invasive alternative. However, the current comparative evidence is limited to observational cohorts, a meta-analysis is needed to address this knowledge gap. METHODS: A literature search was conducted until March 14, 2024, to identify studies comparing LITT and OS in patients with DRE. The primary outcomes were seizure freedom (SF), length of hospital stay (LOS), and complication rate, with subgroup analysis on adult and pediatric populations. RESULTS: Out of 558 articles, 11 cohort studies and 2 retrospective case series met our inclusion criteria, considering 6267 patients for analysis. Patients who underwent LITT had a significantly shorter LOS (Mean Difference [MD] -3.30 days, 95%CI=-4.46, -2.15, p=<0.00001), and a lower complication rate (Risk ratio [RR] 0.49, 95%CI=0.34, 0.72, p=0.0003) compared to OS. The rates of SF favored OS over LITT(RR 0.77, 95%CI=0.69-0.87, p=<0.0001). However, when we analyzed propensity-score matched studies (RR 0.85, 95%CI=0.63-1.15, p=0.30) and temporal lobe epilepsy in pediatric populations (RR 0.78, 95%CI=0.60-1.01, p=0.06), SF rates were comparable among approaches. Mortality was similar among both therapies (RR 0.40, 95%CI=0.06-3.22, p=0.42). CONCLUSIONS: LITT and OS are effective treatments for patients with DRE. Unmatched-cohort analysis suggest that OS might provide superior benefits in terms of SF, conversely, LITT provided a notable advantage in terms of decreased LOS and lower complication rates. However, propensity-score matched cohorts suggest that both approaches may provide comparable SF outcomes. Studies should evaluate critical variables such as neurocognitive decline and quality of life, as this has been underexplored. Future clinical trials are needed to validate these findings.