A multi-center comparison of surgical techniques for corpus Callosotomy in pediatric drug-resistant epilepsy

Daniel Hansen, Jane and John Justin Institute for Mind Health, Cook Children's Medical Center, Fort Worth, Texas, USA.
Sabrina Shandley, Jane and John Justin Institute for Mind Health, Cook Children's Medical Center, Fort Worth, Texas, USA.
Joffre Olaya, Children's Hospital of Orange County, Orange, California, USA.
Jason Hauptman, Division of Pediatric Neurosurgery, University of Washington/Seattle Children's Hospital, Seattle, Washington, USA.
Kurtis Auguste, University of California San Francisco Weill Institute for Neurosciences, Benioff Children's Hospital, San Francisco, California, USA.
Adam P. Ostendorf, Department of Pediatrics, Nationwide Children's Hospital, Ohio State University, Columbus, Ohio, USA.
Dewi F. Depositario-Cabacar, Center for Neuroscience, Children's National Hospital, George Washington University School of Medicine, Washington, District of Columbia, USA.
Lily C. Wong-Kisiel, Department of Neurology, Divisions of Child Neurology and Epilepsy, Mayo Clinic College of Medicine, Rochester, Minnesota, USA.
Shilpa B. Reddy, Department of Pediatric Neurology, Vanderbilt University, Monroe Carell Jr Children's Hospital, Nashville, Tennessee, USA.
Michael J. McCormack, Department of Pediatric Neurology, Vanderbilt University, Monroe Carell Jr Children's Hospital, Nashville, Tennessee, USA.
Ernesto Gonzalez-Giraldo, University of California San Francisco Weill Institute for Neurosciences, Benioff Children's Hospital, San Francisco, California, USA.
Joseph Sullivan, University of California San Francisco Weill Institute for Neurosciences, Benioff Children's Hospital, San Francisco, California, USA.
Javarayee Pradeep, Department of Pediatric Neurology, Children's Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
Rani K. Singh, Division of Neurology, Department of Pediatrics, Atrium Health/Levine Children's Hospital, Charlotte, North Carolina, USA.
Erin Fedak Romanowski, Department of Pediatrics, Division of Pediatric Neurology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA.
Nancy A. McNamara, Department of Pediatrics, Division of Pediatric Neurology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA.
Michael A. Ciliberto, Department of Pediatrics, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA.
Priya Tatachar, Department of Pediatrics, Ann and Robert H Lurie Children's Hospital, Chicago, Illinois, USA.
Daniel W. Shrey, Children's Hospital of Orange County, Orange, California, USA.
Cemal Karakas, Department of Neurology, Norton Children's Hospital, University of Louisville School of Medicine, Louisville, Kentucky, USA.
Samir Karia, Department of Neurology, Norton Children's Hospital, University of Louisville School of Medicine, Louisville, Kentucky, USA.
Ammar Kheder, Department of Pediatrics, Emory University College of Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia, USA.
Satyanarayana Gedela, Department of Pediatrics, Emory University College of Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia, USA.
Allyson Alexander, Department of Neurosurgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.
Krista Eschbach, Department of Neurology, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.
Jeffrey Bolton, Department of Neurology, Boston Children's Hospital, Boston, Massachusetts, USA.
Ahmad Marashly, Department of Neurology, Johns Hopkins Hospital, Baltimore, Maryland, USA.
Steven Wolf, Boston Children's Health Physicians of New York and Connecticut, Maria Fareri Children's Hospital, New York Medical College, Valhalla, New York, USA.
Patricia McGoldrick, Boston Children's Health Physicians of New York and Connecticut, Maria Fareri Children's Hospital, New York Medical College, Valhalla, New York, USA.
Srishti Nangia, Weill-Cornell Medicine, New York City, New York, USA.
Zachary Grinspan, Weill-Cornell Medicine, New York City, New York, USA.
Jason Coryell, Doernbecher Children's Hospital, Oregon Health and Sciences University, Oregon Health Science Center, Portland, Oregon, USA.

Document Type

Journal Article

Publication Date

2-1-2024

Journal

Epilepsia

Volume

65

Issue

2

DOI

10.1111/epi.17853

Keywords

LiTT; minimally invasive; outcomes; seizure; surgery

Abstract

OBJECTIVES: Corpus callosotomy (CC) is used to reduce seizures, primarily in patients with generalized drug-resistant epilepsy (DRE). The invasive nature of the procedure contributes to underutilization despite its potential superiority to other palliative procedures. The goal of this study was to use a multi-institutional epilepsy surgery database to characterize the use of CC across participating centers. METHODS: Data were acquired from the Pediatric Epilepsy Research Consortium (PERC) Surgery Database, a prospective observational study collecting data on children 0-18 years referred for surgical evaluation of DRE across 22 U.S. pediatric epilepsy centers. Patient, epilepsy, and surgical characteristics were collected across multiple CC modalities. Outcomes and complications were recorded and analyzed statistically. RESULTS: Eighty-three patients undergoing 85 CC procedures at 14 participating epilepsy centers met inclusion criteria. Mean age at seizure onset was 2.3 years (0-9.4); mean age for Phase I evaluation and surgical intervention were 9.45 (.1-20) and 10.46 (.2-20.6) years, respectively. Generalized seizure types were the most common (59%). Complete CC was performed in 88%. The majority of CC procedures (57%) were via open craniotomy, followed by laser interstitial thermal therapy (LiTT) (20%) and mini-craniotomy/endoscopic (mc/e) (22%). Mean operative times were significantly longer for LiTT, whereas mean estimated blood loss was greater in open cases. Complications occurred in 11 cases (13%) and differed significantly between surgical techniques (p < .001). There was no statistically significant difference in length of postoperative stay across approaches. Mean follow-up was 12.8 months (range 1-39). Favorable Engel outcomes were experienced by 37 (78.7%) of the patients who underwent craniotomy, 10 (58.8%) with LiTT, and 12 (63.2%) with mc/e; these differences were not statistically significant. SIGNIFICANCE: CC is an effective surgical modality for children with DRE. Regardless of surgical modality, complication rates are acceptable and seizure outcomes generally favorable. Newer, less-invasive, surgical approaches may lead to increased adoption of this efficacious therapeutic option for pediatric DRE.

Department

Neurology

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