Outcomes after anterior or complete corpus callosotomy in children
Aimen S Kasasbeh1, Matthew D Smyth, Karen Steger-May
1*Neural Engineering Laboratory, Mayo Clinic, Rochester, Minnesota; Departments of ‡Neurological Surgery, and §Neurology, St. Louis Children's Hospital, Washington University in St. Louis, St. Louis, Missouri; ¶Division of Biostatistics, Washington University School of Medicine in St. Louis, St. Louis, Missouri.
Insights
Single-stage upfront complete corpus callosotomy (CC) offers superior seizure control in children compared to partial or staged CC. However, potential neurological risks must be considered.
Area of Science:
- Pediatric Neurology
- Neurosurgery
- Epilepsy Management
Background:
- Corpus callosotomy (CC) is a palliative surgery for pediatric epilepsy.
- It is used for medically refractory cases with generalized or multifocal cortical seizure onset.
Purpose of the Study:
- To determine the optimal extent of CC for seizure control in children.
- To evaluate how different CC approaches modify seizure profiles.
Main Methods:
- Retrospective review of 58 pediatric patients (3-22 years) who underwent CC.
- Surgery occurred between 1995 and 2011 for medically refractory epilepsy.
Main Results:
- Anterior two thirds CC resolved absence and astatic seizures.
- Complete CC (single-stage or staged) resolved more seizure types, including GTC, astatic, and myoclonic seizures.
- Single-stage upfront complete CC showed more favorable outcomes than partial or staged CC.
Conclusions:
- Single-stage upfront complete CC is effective for a broader range of pediatric seizure types.
- This approach offers better seizure relief than anterior two thirds or 2-stage CC.
- Potential neurological and operative complications of single-stage complete CC require careful consideration.
Background:
Corpus callosotomy (CC) is a valuable palliative surgical option for children with medically refractory epilepsy due to generalized or multifocal cortical seizure onset.
Objective:
To investigate the extent of CC resulting in optimal seizure control in a pediatric patient population and to evaluate the modification of seizure profile after various CC approaches.
Methods:
The records of 58 children (3-22 years of age at the time of surgery) with medically refractory epilepsy who underwent CC between 1995 and 2011 were retrospectively reviewed.
Results:
Anterior two thirds callosotomy resulted in resolution of absence (P = .03) and astatic (P = .03) seizures, whereas anterior two thirds callosotomy followed by second-stage completion resulted in resolution of generalized tonic-clonic (GTC) (P = .03), astatic (P = .005), and myoclonic (P = .03) seizures in addition to a trend toward resolution of absence seizures (P = .08). Single-stage upfront complete callosotomy resulted in resolution of absence (P = .002), astatic (P < .0001), myoclonic (P = .007), and complex partial (P = .008) seizures in addition to a trend toward resolution of GTC (P = .06). In comparing a composite of subjects who underwent anterior two thirds callosotomy alone or 2-stage complete callosotomy before the second stage to complete the callosotomy with subjects who underwent upfront complete CC, a more favorable outcome was found in those with the upfront complete CC (P = .02).
Conclusion:
Single-stage upfront complete callosotomy is effective in relieving a broader spectrum of seizure types than anterior two thirds callosotomy or 2-stage complete callosotomy in children. The advantages of single-stage complete callosotomy must be weighed against the potentially higher risk of neurological and operative complications.
