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

Daniel Hansen¹, Sabrina Shandley¹, Joffre Olaya², Jason Hauptman³, Kurtis Auguste⁴, Adam P Ostendorf⁵, Dewi F Depositario-Cabacar⁶, Lily C Wong-Kisiel⁷, Shilpa B Reddy⁸, Michael J McCormack⁸, Ernesto Gonzalez-Giraldo⁴, Joseph Sullivan⁴, Javarayee Pradeep⁹, Rani K Singh¹⁰, Erin Fedak Romanowski¹¹, Nancy A McNamara¹¹, Michael A Ciliberto¹², Priya Tatachar¹³, Daniel W Shrey², Cemal Karakas¹⁴, Samir Karia¹⁴, Ammar Kheder¹⁵, Satyanarayana Gedela¹⁵, Allyson Alexander^{16

17}, Krista Eschbach¹⁸, Jeffrey Bolton¹⁹, Ahmad Marashly²⁰, Steven Wolf²¹, Patricia McGoldrick²¹, Srishti Nangia²², Zachary Grinspan²², Jason Coryell²³, Debopam Samanta²⁴, Dallas Armstrong²⁵, M Scott Perry¹

Affiliations

¹ Jane and John Justin Institute for Mind Health, Cook Children's Medical Center, Fort Worth, Texas, USA.
² Children's Hospital of Orange County, Orange, California, USA.
³ Division of Pediatric Neurosurgery, University of Washington/Seattle Children's Hospital, Seattle, Washington, USA.
⁴ University of California San Francisco Weill Institute for Neurosciences, Benioff Children's Hospital, San Francisco, California, USA.
⁵ Department of Pediatrics, Nationwide Children's Hospital, Ohio State University, Columbus, Ohio, USA.
⁶ Center for Neuroscience, Children's National Hospital, George Washington University School of Medicine, Washington, District of Columbia, USA.
⁷ Department of Neurology, Divisions of Child Neurology and Epilepsy, Mayo Clinic College of Medicine, Rochester, Minnesota, USA.
⁸ Department of Pediatric Neurology, Vanderbilt University, Monroe Carell Jr Children's Hospital, Nashville, Tennessee, USA.
⁹ Department of Pediatric Neurology, Children's Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
¹⁰ Division of Neurology, Department of Pediatrics, Atrium Health/Levine Children's Hospital, Charlotte, North Carolina, USA.
¹¹ Department of Pediatrics, Division of Pediatric Neurology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA.
¹² Department of Pediatrics, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA.
¹³ Department of Pediatrics, Ann and Robert H Lurie Children's Hospital, Chicago, Illinois, USA.
¹⁴ Department of Neurology, Norton Children's Hospital, University of Louisville School of Medicine, Louisville, Kentucky, USA.
¹⁵ Department of Pediatrics, Emory University College of Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia, USA.
¹⁶ Department of Neurosurgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.
¹⁷ Division of Pediatric Neurosurgery, Children's Hospital Colorado, Aurora, Colorado, USA.
¹⁸ Department of Neurology, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.
¹⁹ Department of Neurology, Boston Children's Hospital, Boston, Massachusetts, USA.
²⁰ Department of Neurology, Johns Hopkins Hospital, Baltimore, Maryland, USA.
²¹ Boston Children's Health Physicians of New York and Connecticut, Maria Fareri Children's Hospital, New York Medical College, Valhalla, New York, USA.
²² Weill-Cornell Medicine, New York City, New York, USA.
²³ Doernbecher Children's Hospital, Oregon Health and Sciences University, Oregon Health Science Center, Portland, Oregon, USA.
²⁴ Department of Neurology, Arkansas Children's Hospital, Little Rock, Arkansas, USA.
²⁵ Department of Neurology, University of Texas Southwestern, Dallas, Texas, USA.

PMID: 38062633
DOI: 10.1111/epi.17853

Free article

Observational Study

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

Daniel Hansen et al. Epilepsia. 2024 Feb.

Free article

. 2024 Feb;65(2):422-429.

doi: 10.1111/epi.17853. Epub 2023 Dec 22.

Authors

Affiliations

¹ Jane and John Justin Institute for Mind Health, Cook Children's Medical Center, Fort Worth, Texas, USA.
² Children's Hospital of Orange County, Orange, California, USA.
³ Division of Pediatric Neurosurgery, University of Washington/Seattle Children's Hospital, Seattle, Washington, USA.
⁴ University of California San Francisco Weill Institute for Neurosciences, Benioff Children's Hospital, San Francisco, California, USA.
⁵ Department of Pediatrics, Nationwide Children's Hospital, Ohio State University, Columbus, Ohio, USA.
⁶ Center for Neuroscience, Children's National Hospital, George Washington University School of Medicine, Washington, District of Columbia, USA.
⁷ Department of Neurology, Divisions of Child Neurology and Epilepsy, Mayo Clinic College of Medicine, Rochester, Minnesota, USA.
⁸ Department of Pediatric Neurology, Vanderbilt University, Monroe Carell Jr Children's Hospital, Nashville, Tennessee, USA.
⁹ Department of Pediatric Neurology, Children's Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
¹⁰ Division of Neurology, Department of Pediatrics, Atrium Health/Levine Children's Hospital, Charlotte, North Carolina, USA.
¹¹ Department of Pediatrics, Division of Pediatric Neurology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA.
¹² Department of Pediatrics, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA.
¹³ Department of Pediatrics, Ann and Robert H Lurie Children's Hospital, Chicago, Illinois, USA.
¹⁴ Department of Neurology, Norton Children's Hospital, University of Louisville School of Medicine, Louisville, Kentucky, USA.
¹⁵ Department of Pediatrics, Emory University College of Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia, USA.
¹⁶ Department of Neurosurgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.
¹⁷ Division of Pediatric Neurosurgery, Children's Hospital Colorado, Aurora, Colorado, USA.
¹⁸ Department of Neurology, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.
¹⁹ Department of Neurology, Boston Children's Hospital, Boston, Massachusetts, USA.
²⁰ Department of Neurology, Johns Hopkins Hospital, Baltimore, Maryland, USA.
²¹ Boston Children's Health Physicians of New York and Connecticut, Maria Fareri Children's Hospital, New York Medical College, Valhalla, New York, USA.
²² Weill-Cornell Medicine, New York City, New York, USA.
²³ Doernbecher Children's Hospital, Oregon Health and Sciences University, Oregon Health Science Center, Portland, Oregon, USA.
²⁴ Department of Neurology, Arkansas Children's Hospital, Little Rock, Arkansas, USA.
²⁵ Department of Neurology, University of Texas Southwestern, Dallas, Texas, USA.

PMID: 38062633
DOI: 10.1111/epi.17853

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.

Keywords: LiTT; minimally invasive; outcomes; seizure; surgery.

PubMed Disclaimer

Comment in

Any Way You Slice It: Corpus Callosotomy in Pediatric Drug-Resistant Epilepsy.
Fine A. Fine A. Epilepsy Curr. 2024 Apr 17;24(3):156-158. doi: 10.1177/15357597241242243. eCollection 2024 May-Jun. Epilepsy Curr. 2024. PMID: 38898914 Free PMC article. No abstract available.

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

Affiliations

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

Authors

Affiliations

Abstract

Comment in

References

REFERENCES

Publication types

MeSH terms

LinkOut - more resources

Full Text Sources

Medical

Miscellaneous