SynthesisNeurosurgical review2026
Preoperative predictors of seizure freedom after hemispheric surgery for rasmussen's encephalitis: An individual participant data meta-analysis.
Synthesis in Neurosurgical review, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Hemispheric epilepsy surgery is a curative treatment for drug-resistant epilepsy in Rasmussen’s encephalitis (RE), but there is a lack of consensus regarding the preoperative factors influencing long-term outcomes. This study conducted an individual participant data (IPD) meta-analysis to assess the impact of preoperative factors on seizure freedom and report functional outcomes in RE patients undergoing hemispheric surgery. We conducted a systematic search of electronic databases (PubMed, Google Scholar, Embase), identifying 21 studies with a total of 158 participants for IPD meta-analysis. Cox proportional-hazards regression was used to identify independent predictors of seizure recurrence. We also constructed Kaplan-Meier curves and conducted subgroup and sensitivity analyses to validate our findings. In the longest follow-up period, 77.8% (123/158) of patients achieved seizure freedom. Univariate analysis showed that younger age at surgery, shorter seizure duration, hemispherotomy, and right-sided surgical procedures were associated with a longer time to seizure recurrence. In the multivariate and sensitivity analyses, a shorter seizure duration (HR: 0.54, P = 0.044) was an independent predictor of seizure freedom. A subgroup analysis of patients with preoperative language impairment revealed that both hemispherotomy and a shorter seizure duration were associated with a lower risk of recurrence. Postoperative cognitive and motor outcomes were stable or improved in 70.1% and 85.1% of patients, respectively. A shorter preoperative seizure duration is a significant independent predictor of long-term seizure freedom after hemispheric surgery for RE. Our findings highlight the critical importance of early surgical intervention to optimize outcomes. However, due to the small sample size and inherent selection and reporting biases of the included studies, these findings should be interpreted with caution. Our conclusions are based on the best available evidence. Nevertheless, collaborative multicenter studies are needed to validate these findings and establish the optimal timing of surgery.
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