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Outcomes After Anterior or Complete Corpus Callosotomy in Children

Kasasbeh, Aimen S. MD, PhD*; Smyth, Matthew D. MD; Steger-May, Karen MA; Jalilian, Laleh MD; Bertrand, Mary MD§; Limbrick, David D. MD, PhD

doi: 10.1227/NEU.0000000000000197
Research-Human-Clinical Studies

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.

ABBREVIATIONS: CC, corpus callosotomy

CPS, complex partial seizure

GTC, generalized tonic-clonic

SPS, simple partial seizure

VNS, vagal nerve stimulation

*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

Correspondence: Aimen S. Kasasbeh, MD, PhD, Neural Engineering Laboratory, Mayo Clinic, 200 First Street SW, Rochester, MN 55902. E-mail: kasasbeh.aimen@mayo.edu

Received April 04, 2013

Accepted September 25, 2013

Copyright © by the Congress of Neurological Surgeons