A Multi-Center Comparison of Surgical Techniques for Corpus Callosotomy in Pediatric Drug-Resistant Epilepsy
Epilepsia
AUTHORS
Daniel Hansen 1 , Sabrina Shandley 1 , Joffre Olaya 2 , Jason Hauptman 3 , Kurtis Auguste 4 , Adam P Ostendorf 5 , Dewi F Depositario-Cabacar 6 , Lily C Wong-Kisiel 7 , Shilpa B Reddy 8 , Michael J McCormack 8 , Ernesto Gonzalez-Giraldo 4 , Joseph Sullivan 4 , Javarayee Pradeep 9 , Rani K Singh 10 , Erin Fedak Romanowski 11 , Nancy A McNamara 11 , Michael A Ciliberto 12 , Priya Tatachar 13 , Daniel W Shrey 2 , Cemal Karakas 14 , Samir Karia 14 , Ammar Kheder 15 , Satyanarayana Gedela 15 , Allyson Alexander 16 17 , Krista Eschbach 18 , Jeffrey Bolton 19 , Ahmad Marashly 20 , Steven Wolf 21 , Patricia McGoldrick 21 , Srishti Nangia 22 , Zachary Grinspan 22 , Jason Coryell 23 , Debopam Samanta 24 , Dallas Armstrong 25 , M Scott Perry 1
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.