Article Text

Research paper
Systematic review and network meta-analysis of resective surgery for mesial temporal lobe epilepsy
  1. Puneet Jain1,
  2. George Tomlinson2,3,
  3. Carter Snead1,
  4. Beate Sander2,3,
  5. Elysa Widjaja1,3,4
  1. 1Epilepsy Program, Division of Neurology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
  2. 2Toronto Health Economics and Technology Assessment (THETA), University Health Network, Toronto, Ontario, Canada
  3. 3Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
  4. 4Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada
  1. Correspondence to Dr Elysa Widjaja, Diagnostic Imaging, Hospital for Sick Children, Toronto, Ontario ON M5G 1X8, Canada; Elysa.Widjaja{at}


Objective To evaluate the effectiveness of anterior temporal lobectomy (ATL) versus selective amygdalohippocampectomy (SAH) on seizure-free outcome in patients with temporal lobe epilepsy, using both direct and indirect evidence from the literature.

Methods MEDLINE, Embase and Cochrane databases were searched for original research articles and systematic reviews comparing ATL versus SAH, and ATL or SAH versus medical management (MM). The outcome was seizure freedom at 12 months of follow-up or longer. Direct pairwise meta-analyses were conducted, followed by a random-effect Bayesian network meta-analysis (NMA) combining direct and indirect evidence.

Results Twenty-eight articles were included (18 compared ATL vs SAH, 1 compared ATL vs SAH vs MM, 8 compared ATL vs MM, and 1 compared SAH vs MM). Direct pairwise meta-analyses showed no significant differences in seizure-free outcome of ATL versus SAH (OR 1.14, 95% CI 0.93 to 1.39; p=0.201), but the odds of seizure-free outcome were higher for ATL versus MM (OR 29.16, 95% CI 10.44 to 81.50; p<0.00001), and SAH versus MM (OR 28.42, 95% CI 10.17 to 79.39; p<0.00001). NMA also showed that the odds of seizure-free outcome were no different in ATL versus SAH (OR 1.15, 95% credible interval (CrI) 0.84–1.15), but higher for ATL versus MM (OR 27.22, 95% CrI 15.38–27.22), and SAH versus MM (OR 23.57, 95% CrI 12.67–23.57). There were no significant differences between direct and indirect comparisons (all p>0.05).

Conclusion Direct evidence, indirect evidence and NMA did not identify a difference in seizure-free outcome of ATL versus SAH.

Statistics from


  • Contributors EW and PJ planned the study. PJ and EW performed the systematic review and meta-analysis. PJ and EW wrote the first draft of the manuscript. PJ, GT, CS, BS and EW provided inputs for the revision of the first draft of the manuscript and approved the final version.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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