Defining benchmark outcomes for mesial temporal lobe epilepsy surgery: A global multicenter analysis of 1119 cases

Richard Drexler¹, Franz L Ricklefs¹, Sharona Ben-Haim², Anna Rada³, Friedrich Wörmann³, Thomas Cloppenborg³, Christian G Bien³, Matthias Simon^{3

4}, Thilo Kalbhenn^{3

4}, Albert Colon^{5

6}, Kim Rijkers^{6

7

8}, Olaf Schijns^{6

7

8}, Valeri Borger^{9

10}, Rainer Surges^{9

10}, Hartmut Vatter^{9

10}, Michele Rizzi¹¹, Marco de Curtis¹², Giuseppe Didato¹², Nicoló Castelli¹¹, Alexandre Carpentier¹³, Bertrand Mathon¹³, Clarissa Lin Yasuda¹⁴, Fernando Cendes¹⁴, Poodipedi Sarat Chandra¹⁵, Manjari Tripathi¹⁵, Hans Clusmann¹⁶, Daniel Delev¹⁶, Marc Guenot¹⁷, Claire Haegelen¹⁷, Hélène Catenoix¹⁸, Johannes Lang¹⁹, Hajo Hamer¹⁹, Sebastian Brandner¹⁹, Katrin Walther¹⁹, Jason S Hauptmann²⁰, Rosalind L Jeffree²¹, Josua Kegele²², Eliane Weinbrenner²², Georgios Naros²², Julia Velz²³, Niklaus Krayenbühl²³, Julia Onken^{24

25}, Ulf C Schneider²⁶, Martin Holtkamp^{24

27}, Karl Rössler²⁸, Andrea Spyrantis²⁹, Adam Strzelczyk²⁹, Felix Rosenow²⁹, Stefan Stodieck³⁰, Mario A Alonso-Vanegas³¹, Jörg Wellmer³², Tim Wehner³², Lasse Dührsen¹, Jens Gempt¹, Thomas Sauvigny¹

Affiliations

¹ Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
² Department of Neurosurgery, University of California, San Diego, San Diego, California, USA.
³ Department of Epileptology (Krankenhaus Mara), Medical School, Bielefeld University, Bielefeld, Germany.
⁴ Department of Neurosurgery (Evangelisches Klinikum Bethel), Medical School, Bielefeld University, Bielefeld, Germany.
⁵ Department of Epileptology, Academic Center for Epileptology Kempenhaeghe, Heeze, the Netherlands.
⁶ ACE Work Group Epilepsy Surgery Kempenhaeghe/Maastricht University Medical Center+, Maastricht, the Netherlands.
⁷ Department of Neurosurgery, Academic Center for Epileptology UMC/Maastricht University Medical Center+, Maastricht, the Netherlands.
⁸ School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands.
⁹ Department of Neurosurgery, University Hospital Bonn, Bonn, Germany.
¹⁰ Department of Epileptology, University Hospital Bonn, Bonn, Germany.
¹¹ Functional Neurosurgery Unit, Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy.
¹² Epilepsy Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy.
¹³ Department of Neurosurgery, Pitié-Salpêtrière Hospital, Paris, France.
¹⁴ Department of Neurology, University of Campinas, Campinas, Brazil.
¹⁵ Department of Neurosurgery and Neurology, AIIMS, and MEG Resource Facility, New Delhi, India.
¹⁶ Department of Neurosurgery, RWTH Aachen University Hospital, Aachen, Germany.
¹⁷ Department of Functional Neurosurgery, Hospital Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France.
¹⁸ Department of Neurology, Hospices Civils de Lyon, Lyon, France.
¹⁹ Epilepsy Center, Department of Neurology, University of Erlangen-Nuremberg, Erlangen, Germany.
²⁰ Department of Neurosurgery, University of Washington, Seattle, Washington, USA.
²¹ Department of Neurosurgery, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.
²² Department of Neurology and Epileptology, Hertie Institute of Clinical Brain Research, University of Tübingen, Tübingen, Germany.
²³ Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
²⁴ Institute for Diagnostics of Epilepsy, Epilepsy Center Berlin-Brandenburg, Berlin, Germany.
²⁵ Department of Neurosurgery, Charité-Universitätsmedizin Berlin, Berlin, Germany.
²⁶ Department of Neurosurgery, Lucerne Cantonal Hospital, Lucerne, Switzerland.
²⁷ Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany.
²⁸ Department of Neurosurgery, Medical University Vienna, Vienna, Austria.
²⁹ Department of Neurosurgery and Epilepsy Center Frankfurt Rhine-Main, Center of Neurology and Neurosurgery, Goethe University Frankfurt, Frankfurt am Main, Germany.
³⁰ Department of Neurology and Epileptology, Hamburg Epilepsy Center, Protestant Hospital Alsterdorf, Hamburg, Germany.
³¹ National Institute of Neurology and Neurosurgery "Manuel Velasco Suarez", Mexico City, Mexico.
³² Ruhr-Epileptology, Department of Neurology, University Hospital Knappschaftskrankenhaus, Ruhr University Bochum, Bochum, Germany.

PMID: 38400789
DOI: 10.1111/epi.17923

Multicenter Study

Defining benchmark outcomes for mesial temporal lobe epilepsy surgery: A global multicenter analysis of 1119 cases

Richard Drexler et al. Epilepsia. 2024 May.

. 2024 May;65(5):1333-1345.

doi: 10.1111/epi.17923. Epub 2024 Feb 24.

Authors

Affiliations

¹ Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
² Department of Neurosurgery, University of California, San Diego, San Diego, California, USA.
³ Department of Epileptology (Krankenhaus Mara), Medical School, Bielefeld University, Bielefeld, Germany.
⁴ Department of Neurosurgery (Evangelisches Klinikum Bethel), Medical School, Bielefeld University, Bielefeld, Germany.
⁵ Department of Epileptology, Academic Center for Epileptology Kempenhaeghe, Heeze, the Netherlands.
⁶ ACE Work Group Epilepsy Surgery Kempenhaeghe/Maastricht University Medical Center+, Maastricht, the Netherlands.
⁷ Department of Neurosurgery, Academic Center for Epileptology UMC/Maastricht University Medical Center+, Maastricht, the Netherlands.
⁸ School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands.
⁹ Department of Neurosurgery, University Hospital Bonn, Bonn, Germany.
¹⁰ Department of Epileptology, University Hospital Bonn, Bonn, Germany.
¹¹ Functional Neurosurgery Unit, Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy.
¹² Epilepsy Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy.
¹³ Department of Neurosurgery, Pitié-Salpêtrière Hospital, Paris, France.
¹⁴ Department of Neurology, University of Campinas, Campinas, Brazil.
¹⁵ Department of Neurosurgery and Neurology, AIIMS, and MEG Resource Facility, New Delhi, India.
¹⁶ Department of Neurosurgery, RWTH Aachen University Hospital, Aachen, Germany.
¹⁷ Department of Functional Neurosurgery, Hospital Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France.
¹⁸ Department of Neurology, Hospices Civils de Lyon, Lyon, France.
¹⁹ Epilepsy Center, Department of Neurology, University of Erlangen-Nuremberg, Erlangen, Germany.
²⁰ Department of Neurosurgery, University of Washington, Seattle, Washington, USA.
²¹ Department of Neurosurgery, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.
²² Department of Neurology and Epileptology, Hertie Institute of Clinical Brain Research, University of Tübingen, Tübingen, Germany.
²³ Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
²⁴ Institute for Diagnostics of Epilepsy, Epilepsy Center Berlin-Brandenburg, Berlin, Germany.
²⁵ Department of Neurosurgery, Charité-Universitätsmedizin Berlin, Berlin, Germany.
²⁶ Department of Neurosurgery, Lucerne Cantonal Hospital, Lucerne, Switzerland.
²⁷ Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany.
²⁸ Department of Neurosurgery, Medical University Vienna, Vienna, Austria.
²⁹ Department of Neurosurgery and Epilepsy Center Frankfurt Rhine-Main, Center of Neurology and Neurosurgery, Goethe University Frankfurt, Frankfurt am Main, Germany.
³⁰ Department of Neurology and Epileptology, Hamburg Epilepsy Center, Protestant Hospital Alsterdorf, Hamburg, Germany.
³¹ National Institute of Neurology and Neurosurgery "Manuel Velasco Suarez", Mexico City, Mexico.
³² Ruhr-Epileptology, Department of Neurology, University Hospital Knappschaftskrankenhaus, Ruhr University Bochum, Bochum, Germany.

PMID: 38400789
DOI: 10.1111/epi.17923

Abstract

Objective: Benchmarking has been proposed to reflect surgical quality and represents the highest standard reference values for desirable results. We sought to determine benchmark outcomes in patients after surgery for drug-resistant mesial temporal lobe epilepsy (MTLE).

Methods: This retrospective multicenter study included patients who underwent MTLE surgery at 19 expert centers on five continents. Benchmarks were defined for 15 endpoints covering surgery and epilepsy outcome at discharge, 1 year after surgery, and the last available follow-up. Patients were risk-stratified by applying outcome-relevant comorbidities, and benchmarks were calculated for low-risk ("benchmark") cases. Respective measures were derived from the median value at each center, and the 75th percentile was considered the benchmark cutoff.

Results: A total of 1119 patients with a mean age (range) of 36.7 (1-74) years and a male-to-female ratio of 1:1.1 were included. Most patients (59.2%) underwent anterior temporal lobe resection with amygdalohippocampectomy. The overall rate of complications or neurological deficits was 14.4%, with no in-hospital death. After risk stratification, 377 (33.7%) benchmark cases of 1119 patients were identified, representing 13.6%-72.9% of cases per center and leaving 742 patients in the high-risk cohort. Benchmark cutoffs for any complication, clinically apparent stroke, and reoperation rate at discharge were ≤24.6%, ≤.5%, and ≤3.9%, respectively. A favorable seizure outcome (defined as International League Against Epilepsy class I and II) was reached in 83.6% at 1 year and 79.0% at the last follow-up in benchmark cases, leading to benchmark cutoffs of ≥75.2% (1-year follow-up) and ≥69.5% (mean follow-up of 39.0 months).

Significance: This study presents internationally applicable benchmark outcomes for the efficacy and safety of MTLE surgery. It may allow for comparison between centers, patient registries, and novel surgical and interventional techniques.

Keywords: benchmarking; neurosurgery; outcome; quality; seizure.

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References

REFERENCES

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Defining benchmark outcomes for mesial temporal lobe epilepsy surgery: A global multicenter analysis of 1119 cases

Affiliations

Defining benchmark outcomes for mesial temporal lobe epilepsy surgery: A global multicenter analysis of 1119 cases

Authors

Affiliations

Abstract

References

REFERENCES

Publication types

MeSH terms

LinkOut - more resources

Full Text Sources