A Multi-center Comparison of Surgical Technique for Corpus Callosotomy in Pediatric Drug Resistant Epilepsy.

Overview

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 contribute to underutilization despite 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 was 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 US pediatric epilepsy centers. Patient, epilepsy, and surgical characteristics were collected across multiple CC modalities. Outcomes and complications were recorded and statistically analyzed. RESULTS: 83 patients undergoing 85 CC procedures at 14 participating epilepsy centers met inclusion criteria. Mean age at seizure onset at 2.3 years (0-9.4), mean age for Phase I evaluation and surgical intervention were 9.45 (0.1-20) and 10.46 (0.2-20.6) years. Generalized seizure types were the most common (59%). Complete CC was performed in 88%. The majority of CC (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 while mean estimated blood loss was greater in open cases. Complications occurred in 11 (13%) cases and differed significantly between surgical technique (p <0.001). There was no significant difference in length of post-operative stay across approaches.. Mean follow up was 12.8 months (range 1-39). 37 (78.7%) of the cohort undergoing open craniotomy, 10 (58.8%) LiTT and 12 (63.2%) endoscopic experienced favorable Engel outcomes; which was not statistically different. 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.