TY - JOUR
T1 - A multi-center comparison of surgical techniques for corpus Callosotomy in pediatric drug-resistant epilepsy
AU - Hansen, Daniel
AU - Shandley, Sabrina
AU - Olaya, Joffre
AU - Hauptman, Jason
AU - Auguste, Kurtis
AU - Ostendorf, Adam P.
AU - Depositario-Cabacar, Dewi F.
AU - Wong-Kisiel, Lily C.
AU - Reddy, Shilpa B.
AU - McCormack, Michael J.
AU - Gonzalez-Giraldo, Ernesto
AU - Sullivan, Joseph
AU - Pradeep, Javarayee
AU - Singh, Rani K.
AU - Romanowski, Erin Fedak
AU - McNamara, Nancy A.
AU - Ciliberto, Michael A.
AU - Tatachar, Priya
AU - Shrey, Daniel W.
AU - Karakas, Cemal
AU - Karia, Samir
AU - Kheder, Ammar
AU - Gedela, Satyanarayana
AU - Alexander, Allyson
AU - Eschbach, Krista
AU - Bolton, Jeffrey
AU - Marashly, Ahmad
AU - Wolf, Steven
AU - McGoldrick, Patricia
AU - Nangia, Srishti
AU - Grinspan, Zachary
AU - Coryell, Jason
AU - Samanta, Debopam
AU - Armstrong, Dallas
AU - Perry, M. Scott
N1 - Publisher Copyright:
© 2023 International League Against Epilepsy.
PY - 2024/2
Y1 - 2024/2
N2 - 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.
AB - 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.
KW - LiTT
KW - minimally invasive
KW - outcomes
KW - seizure
KW - surgery
UR - http://www.scopus.com/inward/record.url?scp=85180687556&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85180687556&partnerID=8YFLogxK
U2 - 10.1111/epi.17853
DO - 10.1111/epi.17853
M3 - Article
C2 - 38062633
AN - SCOPUS:85180687556
SN - 0013-9580
VL - 65
SP - 422
EP - 429
JO - Epilepsia
JF - Epilepsia
IS - 2
ER -