立体定向脑电图（SEEG）引导射频热凝后的后续癫痫手术：结局及治疗反应的预后价值——一项系统综述与荟萃分析。
完整摘要 · 中文译文
立体脑电图引导射频热凝（SEEG-RFTC）不仅被用作药物难治性局灶性癫痫的微创治疗手段，也被用作对SEEG所定义的致痫网络进行体内测试的方法。射频热凝（RFTC）的反应是否与后续手术的结局相关仍不确定。我们评估了随后进行的切除性、离断性或消融性手术后的癫痫发作结局，以及RFTC反应与后续手术结局之间的关联。检索了PubMed/MEDLINE、Embase、Scopus和Web of Science，检索时间自建库至2026年6月1日。符合条件的研究包括接受SEEG-RFTC治疗并报告治疗、安全性、下游治疗或术后结局的患者。单臂结局采用随机效应logit模型进行合并。稀疏的永久性并发症数据采用随机截距logistic模型分析，反应者与非反应者的比较采用随机效应比值比；Hartung-Knapp推断作为小样本敏感性分析予以检验。偏倚风险采用Joanna Briggs Institute工具评估，并对纳入预后荟萃分析的3项研究额外采用预后研究质量（Quality In Prognosis Studies）评估。29项原始临床研究符合纳入标准。6项研究共194例患者报告了符合条件的后续切除性、离断性或消融性癫痫手术后可提取的结局；141例患者获得良好的癫痫发作结局。合并的良好结局比例为72.4%（95%置信区间[CI]，65.6%-78.3%；I2 = 0%）。 三项研究直接比较了应答者与无应答者。在常规随机效应模型下，应答者获得良好后期结局的比值在数值上更高（比值比，3.86；95% CI，0.80-18.57；I2 = 47.1%），但Hartung-Knapp小样本推断大幅拓宽了不确定性（比值比，3.86；95% CI，0.19-77.91；P = .193）。后续接受另一项癫痫手术的合并比例为22.0%（95% CI，11.1%-38.8%），不同临床路径间存在显著异质性（I2 = 84.1%），而永久性神经系统并发症发生率为2.7%（95% CI，1.0%-6.9%）。在接受SEEG-RFTC后进一步行切除性、离断性或消融性癫痫手术的精选患者中，约十分之七获得了良好的发作结局。RFTC阳性应答可能增强对手术假设的信心，但当前证据尚未确立其独立预后价值。当前证据不支持仅凭RFTC无应答将原本合适的候选者排除在确定性癫痫手术之外。因此，SEEG-RFTC可作为基于网络的手术评估中提供决策信息的组成部分，而非仅作为局灶性消融治疗。
完整摘要 · 英文原文
Stereoelectroencephalography-guided radiofrequency thermocoagulation (SEEG-RFTC) is used not only as a minimally invasive treatment for drug-resistant focal epilepsy, but also as an in vivo test of an SEEG-defined epileptogenic network. Whether response to RFTC is associated with the outcome of subsequent surgery remains uncertain. We evaluated seizure outcomes after later resective, disconnective, or ablative surgery and the association between RFTC response and later surgical outcome. PubMed/MEDLINE, Embase, Scopus, and Web of Science were searched from inception to June 1, 2026. Eligible studies included patients treated with SEEG-RFTC and reporting therapeutic, safety, downstream-treatment, or postsurgical outcomes. Single-arm outcomes were pooled using random-effects logit models. Sparse permanent-complication data were analyzed with a random-intercept logistic model, and responder-versus-nonresponder comparisons with random-effects odds ratios; Hartung-Knapp inference was examined as a small-sample sensitivity analysis. Risk of bias was assessed using Joanna Briggs Institute tools, with additional Quality In Prognosis Studies assessment of the three studies contributing to the prognostic meta-analysis. Twenty-nine original clinical studies met the eligibility criteria. Six studies comprising 194 patients reported extractable outcomes after qualifying subsequent resective, disconnective, or ablative epilepsy surgery; 141 patients achieved a favorable seizure outcome. The pooled favorable-outcome proportion was 72.4% (95% confidence interval [CI], 65.6%-78.3%; I2 = 0%). Three studies directly compared responders with nonresponders. Responders had numerically higher odds of favorable later outcome under the conventional random-effects model (odds ratio, 3.86; 95% CI, 0.80-18.57; I2 = 47.1%), but Hartung-Knapp small-sample inference substantially widened the uncertainty (odds ratio, 3.86; 95% CI, 0.19-77.91; P = .193). The pooled proportion proceeding to another epilepsy procedure was 22.0% (95% CI, 11.1%-38.8%), with substantial heterogeneity across clinical pathways (I2 = 84.1%), while permanent neurological complications occurred in 2.7% (95% CI, 1.0%-6.9%). Approximately seven of 10 selected patients had a favorable seizure outcome after subsequent resective, disconnective, or ablative epilepsy surgery following SEEG-RFTC. A positive RFTC response may strengthen confidence in the surgical hypothesis, but current evidence does not establish independent prognostic value. Current evidence does not support using RFTC nonresponse alone to exclude an otherwise appropriate candidate from definitive epilepsy surgery. SEEG-RFTC may therefore serve as a decision-informing component of network-based surgical evaluation rather than solely as a focal ablative treatment.