Stereotactic Laser Ablation vs Open Corpus Callosotomy: A Systematic Review and Meta-Analysis of Individual Patient Data

BACKGROUND AND OBJECTIVES: This study compares seizure outcomes and complication rates between open corpus callosotomy (CC) and laser interstitial thermal therapy (LITT) CC in adult and pediatric patients with medically refractory generalized epilepsy. Although CC is a palliative option for nonresectable foci, the efficacy and safety of LITT CC compared with open CC remain unclear. METHODS: We conducted a systematic review and individual patient data meta-analysis following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Eligible studies reported individual seizure outcomes for open or LITT CC patients. Studies involving concurrent resection or neuromodulation were excluded. RESULTS: We analyzed 72 studies (948 patients: 858 open CC, 90 LITT CC) published between January 1980 and February 2024. Overall seizure freedom rates were similar (LITT CC: 14.5% vs open CC: 19.95%; P = .25), as were drop attack freedom (51.3% vs 45.1%; P = .34) and >50% seizure reduction rates (52.6% vs 55.2%; P = .78). LITT CC had shorter hospital stays (median: 2 vs 6 days; P < .0001) but with more subsequent epilepsy surgeries (24.4% vs 10.1%; P = .0003). Complication rates were comparable (LITT CC: 31.3% vs open CC: 22.9%; P = .1), but LITT CC with 1-2 trajectories had significantly lower complications than those with 3 to 5 trajectories (13.2% vs 54.8%, P = .0003). Neither intervention type nor callosotomy extent influenced seizure outcomes in multivariable logistic regression analyses, stratified by age and follow-up duration. In adults, vagal nerve stimulation before CC was an independent predictor of drop attack freedom (odds ratio = 3.51 [1.16-11.58], P = .03) and Lennox-Gastaut syndrome was an independent predictor of seizure freedom (odds ratio = 3.65 [1.35-10.33], P = .01). CONCLUSION: Both procedures offer comparable effectiveness, suggesting LITT CC is a viable minimally invasive alternative; further experience is needed.