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Ma Y, Kaminski M, Kim A. Surgical treatment of epileptic encephalopathy with spike-and-wave activation in sleep: A systematic review and meta-analysis. Seizure 2024; 119:78-83. [PMID: 38820673 DOI: 10.1016/j.seizure.2024.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 04/27/2024] [Accepted: 05/15/2024] [Indexed: 06/02/2024] Open
Abstract
OBJECTIVE Epileptic Encephalopathy / Developmental Epileptic Encephalopathy with spike-and-wave activation during sleep (EE/DEE-SWAS) is a self-limiting childhood epilepsy syndrome but may cause permanent neurocognitive impairment. Surgical interventions have been controversial in the treatment of EE/DEE-SWAS. This systematic review aims to evaluate the efficacy of various surgical procedures on the outcomes of EE/DEE-SWAS. METHODS A systematic review was performed per the PRISMA guidelines. A total of 14 retrospective studies were identified, comprising 131 cases of EE/DEE-SWAS treated with epilepsy surgery. The review analyzed presurgical data, surgical interventions, as well as outcomes related to seizures, EEG, and neuropsychological assessments. RESULTS Epilepsy surgery was successfully performed in 131 cases with minor complications. The average age was 2.6 years at seizure onset and 5.0 years at diagnosis of SWAS. Excellent seizure control (Engel I and II) was achieved in 80.6 %, 78.6 %, 77.4 % and 27.2 % of patients receiving hemispherectomies, focal resections, multiple subpial transections (MSTs), and corpus callosotomies (CCTs), respectively. EEG SWAS resolution was seen in 79.7 % of hemispherectomy cases, 78.6 % in focal resections, 63.9 % in MSTs, and 8.3 % in CCTs. Neurocognitive and behavioral improvement was noted in 58.0 %, 71.4 %, 58.3 % and 16.7 % for patients receiving hemispherectomies, focal resections, MSTs, and CCTs, respectively. A correlation between improved seizure control and SWAS resolution was observed with improved neuropsychological outcomes. CONCLUSION Epilepsy surgery is a safe and effective treatment for carefully selected children with drug-resistant EE/DEE-SWAS. Patients who underwent epilepsy surgery had reduction of seizure burden, SWAS resolution and improvements in neurocognitive and behavioral function.
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Affiliation(s)
- Yitao Ma
- Department of Neurology, Walter Reed National Military Medical Center, Bethesda, MD, USA.
| | | | - Alex Kim
- Department of Neurology, Walter Reed National Military Medical Center, Bethesda, MD, USA
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Niazi F, Han A, Stamm L, Shlobin NA, Korman C, Hoang TS, Kielian A, Du Pont-Thibodeau G, Ducharme Crevier L, Major P, Nguyen DK, Bouthillier A, Ibrahim GM, Fallah A, Hadjinicolaou A, Weil AG. Outcome of emergency neurosurgery in patients with refractory and super-refractory status epilepticus: a systematic review and individual participant data meta-analysis. Front Neurol 2024; 15:1403266. [PMID: 38863514 PMCID: PMC11165020 DOI: 10.3389/fneur.2024.1403266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Accepted: 04/23/2024] [Indexed: 06/13/2024] Open
Abstract
Background Refractory (RSE) and super-refractory status epilepticus (SRSE) are serious neurological conditions requiring aggressive management. Beyond anesthetic agents, there is a lack of evidence guiding management in these patients. This systematic review and individual participant data meta-analysis (IPDMA) seeks to evaluate and compare the currently available surgical techniques for the acute treatment of RSE and SRSE. Methods A systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Individual Participant Data (PRISMA-IPD). Only patients who underwent surgery while in RSE and SRSE were included. Descriptive statistics were used to compare various subgroups. Multivariable logistic regression models were constructed to identify predictors of status epilepticus (SE) cessation, long-term overall seizure freedom, and favorable functional outcome (i.e., modified Rankin score of 0-2) at last follow-up. Results A total of 87 studies including 161 participants were included. Resective surgery tended to achieve better SE cessation rate (93.9%) compared to non-resective techniques (83.9%), but this did not reach significance (p = 0.071). Resective techniques were also more likely to achieve seizure freedom (69.1% vs. 34.4%, p = <0.0001). Older age at SE (OR = 1.384[1.046-1.832], p = 0.023) was associated with increased likelihood of SE cessation, while longer duration of SE (OR = 0.603[0.362-1.003], p = 0.051) and new-onset seizures (OR = 0.244[0.069-0.860], p = 0.028) were associated with lower likelihood of SE cessation, but this did not reach significance for SE duration. Only shorter duration of SE prior to surgery (OR = 1.675[1.168-2.404], p = 0.0060) and immediate termination of SE (OR = 3.736 [1.323-10.548], p = 0.014) were independently associated with long-term seizure status. Rates of favorable functional outcomes (mRS of 0-2) were comparable between resective (44.4%) and non-resective (44.1%) techniques, and no independent predictors of outcome were identified. Conclusion Our findings suggest that emergency neurosurgery may be a safe and effective alternative in patients with RSE/SRSE and may be considered earlier during the disease course. However, the current literature is limited exclusively to small case series and case reports with high risk of publication bias. Larger clinical trials assessing long-term seizure and functional outcomes are warranted to establish robust management guidelines.
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Affiliation(s)
- Farbod Niazi
- Department of Medicine, Université de Montréal, Montreal, QC, Canada
- Brain and Development Research Axis, CHU Sainte-Justine Research Centre, Montreal, QC, Canada
| | - Aline Han
- Department of Medicine, Université de Montréal, Montreal, QC, Canada
- Brain and Development Research Axis, CHU Sainte-Justine Research Centre, Montreal, QC, Canada
| | - Lauren Stamm
- Brain and Development Research Axis, CHU Sainte-Justine Research Centre, Montreal, QC, Canada
- Department of Medicine, McGill University, Montreal, QC, Canada
| | - Nathan A. Shlobin
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Catherine Korman
- Brain and Development Research Axis, CHU Sainte-Justine Research Centre, Montreal, QC, Canada
- Department of Medicine, McGill University, Montreal, QC, Canada
| | - Thien S. Hoang
- Department of Health Sciences, Université de Montréal, Montreal, QC, Canada
| | - Agnieszka Kielian
- Department of Neurology, Boston Children’s Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
| | - Genevieve Du Pont-Thibodeau
- Division of Pediatric Intensive Care, Department of Pediatrics, Sainte-Justine University Hospital Centre, Montreal, QC, Canada
| | - Laurence Ducharme Crevier
- Division of Pediatric Intensive Care, Department of Pediatrics, Sainte-Justine University Hospital Centre, Montreal, QC, Canada
| | - Philippe Major
- Brain and Development Research Axis, CHU Sainte-Justine Research Centre, Montreal, QC, Canada
- Division of Neurology, Department of Pediatrics, Sainte-Justine University Hospital Centre, Montreal, QC, Canada
- Department of Neuroscience, Université de Montréal, Montreal, QC, Canada
| | - Dang K. Nguyen
- Department of Neuroscience, Université de Montréal, Montreal, QC, Canada
- Division of Neurology, University of Montreal Hospital Center (CHUM), Montreal, QC, Canada
| | - Alain Bouthillier
- Division of Neurosurgery, Department of Surgery, University of Montreal Hospital Center (CHUM), Montreal, QC, Canada
| | - George M. Ibrahim
- Division of Neurosurgery, Hospital for Sick Children, Toronto, ON, Canada
- Neurosciences and Mental Health, SickKids Research Institute, Toronto, ON, Canada
| | - Aria Fallah
- Department of Neurosurgery, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA, United States
| | - Aristides Hadjinicolaou
- Brain and Development Research Axis, CHU Sainte-Justine Research Centre, Montreal, QC, Canada
- Division of Neurology, Department of Pediatrics, Sainte-Justine University Hospital Centre, Montreal, QC, Canada
- Department of Neuroscience, Université de Montréal, Montreal, QC, Canada
| | - Alexander G. Weil
- Brain and Development Research Axis, CHU Sainte-Justine Research Centre, Montreal, QC, Canada
- Department of Neuroscience, Université de Montréal, Montreal, QC, Canada
- Division of Neurosurgery, Department of Surgery, University of Montreal Hospital Center (CHUM), Montreal, QC, Canada
- Division of Neurosurgery, Department of Surgery, Sainte-Justine University Hospital Centre, Montreal, QC, Canada
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Hale AT, Barkley AS, Blount JP. Corpus Callosotomy Is a Safe and Effective Procedure for Medically Resistant Epilepsy. Adv Tech Stand Neurosurg 2023; 48:355-369. [PMID: 37770691 DOI: 10.1007/978-3-031-36785-4_13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2023]
Abstract
Corpus callosotomy (CC) is an effective surgical treatment for medically resistant generalized or multifocal epilepsy (MRE). The premise of CC extrapolates from the observation that the corpus callosum is the predominant commissural pathway that allows spread and synchroneity of epileptogenic activity between the hemispheres. Candidacy for CC is typically reserved for patients seeking palliative epilepsy treatment with the goal of reducing the frequency of drop attacks, although reduction of other seizure semiologies (absence, complex partial seizures, and tonic-clonic) has been observed. A reduction in morbidity affiliated with evolution of surgical techniques to perform CC has improved the safety profile of the procedure without necessarily sacrificing efficacy.
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Affiliation(s)
- Andrew T Hale
- Division of Pediatric Neurosurgery, Children's of Alabama, Birmingham, AL, USA
| | - Ariana S Barkley
- Division of Pediatric Neurosurgery, Children's of Alabama, Birmingham, AL, USA
| | - Jeffrey P Blount
- Division of Pediatric Neurosurgery, Children's of Alabama, Birmingham, AL, USA.
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Uchida D, Ono T, Honda R, Watanabe Y, Toda K, Baba S, Matsuo T, Baba H. Asymmetric epileptic spasms after corpus callosotomy in children with West syndrome may be a good indicator for unilateral epileptic focus and subsequent resective surgery. Epilepsia Open 2022; 7:474-487. [PMID: 35869791 PMCID: PMC9436295 DOI: 10.1002/epi4.12631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 07/18/2022] [Indexed: 11/06/2022] Open
Affiliation(s)
- Daiki Uchida
- Department of Neurosurgery, National Hospital Organization Nagasaki Medical Center, Omura Nagasaki Japan
- Department of Neurosurgery Nagasaki University Graduate School of Biomedical Sciences Nagasaki Japan
| | - Tomonori Ono
- Department of Neurosurgery, National Hospital Organization Nagasaki Medical Center, Omura Nagasaki Japan
- Epilepsy Center, National Hospital Organization Nagasaki Medical Center, Omura Nagasaki Japan
| | - Ryoko Honda
- Epilepsy Center, National Hospital Organization Nagasaki Medical Center, Omura Nagasaki Japan
- Department of Pediatrics, National Hospital Organization Nagasaki Medical Center, Omura Nagasaki Japan
| | - Yoshiaki Watanabe
- Epilepsy Center, National Hospital Organization Nagasaki Medical Center, Omura Nagasaki Japan
- Department of Pediatrics, National Hospital Organization Nagasaki Medical Center, Omura Nagasaki Japan
| | - Keisuke Toda
- Department of Neurosurgery, National Hospital Organization Nagasaki‐Kawatana Medical Center, Kawatana Nagasaki Japan
| | - Shiro Baba
- Department of Neurosurgery Nagasaki University Graduate School of Biomedical Sciences Nagasaki Japan
| | - Takayuki Matsuo
- Department of Neurosurgery Nagasaki University Graduate School of Biomedical Sciences Nagasaki Japan
| | - Hiroshi Baba
- Epilepsy Center, Nishi‐Isahaya Hospital, Isahaya Nagasaki Japan
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5
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Kosugi K, Iijima K, Yokosako S, Takayama Y, Kimura Y, Kaneko Y, Sumitomo N, Saito T, Nakagawa E, Sato N, Iwasaki M. Low EEG Gamma Entropy and Glucose Hypometabolism After Corpus Callosotomy Predicts Seizure Outcome After Subsequent Surgery. Front Neurol 2022; 13:831126. [PMID: 35401399 PMCID: PMC8989433 DOI: 10.3389/fneur.2022.831126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 02/09/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundPatients with generalized epilepsy who had lateralized EEG abnormalities after corpus callosotomy (CC) occasionally undergo subsequent surgeries to control intractable epilepsy.ObjectivesThis study evaluated retrospectively the combination of EEG multiscale entropy (MSE) and FDG-PET for identifying lateralization of the epileptogenic zone after CC.MethodsThis study included 14 patients with pharmacoresistant epilepsy who underwent curative epilepsy surgery after CC. Interictal scalp EEG and FDG-PET obtained after CC were investigated to determine (1) whether the MSE calculated from the EEG and FDG-PET findings was lateralized to the surgical side, and (2) whether the lateralization was associated with seizure outcomes.ResultsSeizure reduction rate was higher in patients with lateralized findings to the surgical side than those without (MSE: p < 0.05, FDG-PET: p < 0.05, both: p < 0.01). Seizure free rate was higher in patients with lateralized findings in both MSE and FDG-PET than in those without (p < 0.05).ConclusionsThis study demonstrated that patients with lateralization of MSE and FDG-PET to the surgical side had better seizure outcomes. The combination of MSE and conventional FDG-PET may help to select surgical candidates for additional surgery after CC with good postoperative seizure outcomes.
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Affiliation(s)
- Kenzo Kosugi
- Department of Neurosurgery, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Japan
| | - Keiya Iijima
- Department of Neurosurgery, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Japan
| | - Suguru Yokosako
- Department of Neurosurgery, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Japan
| | - Yutaro Takayama
- Department of Neurosurgery, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Japan
| | - Yuiko Kimura
- Department of Neurosurgery, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Japan
| | - Yuu Kaneko
- Department of Neurosurgery, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Japan
| | - Noriko Sumitomo
- Department of Child Neurology, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Japan
| | - Takashi Saito
- Department of Child Neurology, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Japan
| | - Eiji Nakagawa
- Department of Child Neurology, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Japan
| | - Noriko Sato
- Department of Radiology, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Japan
| | - Masaki Iwasaki
- Department of Neurosurgery, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Japan
- *Correspondence: Masaki Iwasaki
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Complete callosotomy in children with drop attacks; A retrospective monocentric study of 50 patients. Seizure 2022; 96:34-42. [DOI: 10.1016/j.seizure.2022.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 01/10/2022] [Accepted: 01/12/2022] [Indexed: 11/19/2022] Open
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Corpus Callosotomy in 3 Cavalier King Charles Spaniel Dogs with Drug-Resistant Epilepsy. Brain Sci 2021; 11:brainsci11111462. [PMID: 34827461 PMCID: PMC8615928 DOI: 10.3390/brainsci11111462] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 11/02/2021] [Accepted: 11/02/2021] [Indexed: 12/13/2022] Open
Abstract
Corpus callosotomy (CC) is an established palliative surgery for human patients with drug-resistant epilepsy (DRE), especially those with generalized seizures and multiple or unknown epileptogenic focus. However, there are no reports to describe CC in canine patients with epilepsy. Three client-owned Cavalier King Charles Spaniels with DRE are included in this case series. In presurgical evaluations, an apparent epileptogenic zone was not detected in each dog and CC was conducted. Total CC was performed in one dog, whereas the other two received partial CC. One dog recovered from surgery without any complications, but died suddenly by an unknown cause at 10 h after surgery. For the other two dogs, postoperative evaluations including seizure outcomes, complications, and quality of life of the dogs and owners were assessed for at least 12 months. Both dogs showed a remarkable decrease in seizure frequency (averaged 80.3% reduction) and severity after surgery. The antiseizure medications were maintained, and not only the mentation and activity of the dogs, but also the quality of life of dogs and owners were improved postoperatively. Although technical improvement and more large-scale studies are needed, CC is a treatment option for dogs with DRE in veterinary medicine.
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Khuvis S, Hwang ST, Mehta AD. Intracranial EEG Biomarkers for Seizure Lateralization in Rapidly-Bisynchronous Epilepsy After Laser Corpus Callosotomy. Front Neurol 2021; 12:696492. [PMID: 34690909 PMCID: PMC8531267 DOI: 10.3389/fneur.2021.696492] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 09/06/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: It has been asserted that high-frequency analysis of intracranial EEG (iEEG) data may yield information useful in localizing epileptogenic foci. Methods: We tested whether proposed biomarkers could predict lateralization based on iEEG data collected prior to corpus callosotomy (CC) in three patients with bisynchronous epilepsy, whose seizures lateralized definitively post-CC. Lateralization data derived from algorithmically-computed ictal phase-locked high gamma (PLHG), high gamma amplitude (HGA), and low-frequency (filtered) line length (LFLL), as well as interictal high-frequency oscillation (HFO) and interictal epileptiform discharge (IED) rate metrics were compared against ground-truth lateralization from post-CC ictal iEEG. Results: Pre-CC unilateral IEDs were more frequent on the more-pathologic side in all subjects. HFO rate predicted lateralization in one subject, but was sensitive to detection threshold. On pre-CC data, no ictal metric showed better predictive power than any other. All post-corpus callosotomy seizures lateralized to the pathological hemisphere using PLHG, HGA, and LFLL metrics. Conclusions: While quantitative metrics of IED rate and ictal HGA, PHLG, and LFLL all accurately lateralize based on post-CC iEEG, only IED rate consistently did so based on pre-CC data. Significance: Quantitative analysis of IEDs may be useful in lateralizing seizure pathology. More work is needed to develop reliable techniques for high-frequency iEEG analysis.
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Affiliation(s)
- Simon Khuvis
- Department of Neurosurgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, United States.,Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, United States
| | - Sean T Hwang
- Department of Neurology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, United States
| | - Ashesh D Mehta
- Department of Neurosurgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, United States.,Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, United States
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Harris WB, Phillips HW, Fallah A, Mathern GW. Pediatric Epilepsy Surgery in Focal and Generalized Epilepsy: Current Trends and Recent Advancements. JOURNAL OF PEDIATRIC EPILEPSY 2021. [DOI: 10.1055/s-0040-1722298] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
AbstractFor a subset of children with medically intractable epilepsy, surgery may provide the best chances of seizure freedom. Whereas the indications for epilepsy surgery are commonly thought to be limited to patients with focal epileptogenic foci, modern imaging and surgical interventions frequently permit successful surgical treatment of generalized epilepsy. Resection continues to be the only potentially curative intervention; however, the advent of various neuromodulation interventions provides an effective palliative strategy for generalized or persistent seizures. Although the risks and benefits vary greatly by type and extent of intervention, the seizure outcomes appear to be uniformly favorable. Advances in both resective and nonresective surgical interventions provide promise for improved seizure freedom, function, and quality of life. This review summarizes the current trends and recent advancements in pediatric epilepsy surgery from diagnostic workup and indications through surgical interventions and postoperative outcomes.
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Affiliation(s)
- William B. Harris
- John A. Burns School of Medicine, University of Hawai'i, Honolulu, Hawai'i
| | - H. Westley Phillips
- Department of Neurosurgery, University of California Los Angeles, California, United States
| | - Aria Fallah
- Department of Neurosurgery, University of California Los Angeles, California, United States
| | - Gary W. Mathern
- Department of Neurosurgery, University of California Los Angeles, California, United States
- Department of Psychiatry and Biobehavioral Medicine, David Geffen School of Medicine at UCLA, California, United States
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Lehner KR, Yeagle EM, Argyelan M, Klimaj Z, Du V, Megevand P, Hwang ST, Mehta AD. Validation of corpus callosotomy after laser interstitial thermal therapy: a multimodal approach. J Neurosurg 2018; 131:1095-1105. [PMID: 30497188 DOI: 10.3171/2018.4.jns172588] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2017] [Accepted: 04/17/2018] [Indexed: 11/06/2022]
Abstract
Objective Disconnection of the cerebral hemispheres by corpus callosotomy (CC) is an established means to palliate refractory generalized epilepsy. Laser interstitial thermal therapy (LITT) is gaining acceptance as a minimally invasive approach to treating epilepsy, but this method has not been evaluated in clinical series using established methodologies to assess connectivity. The goal in this study was to demonstrate the safety and feasibility of MRI-guided LITT for CC and to assess disconnection by using electrophysiology- and imaging-based methods. Methods Retrospective chart and imaging review was performed in 5 patients undergoing LITT callosotomy at a single center. Diffusion tensor imaging and resting functional MRI were performed in all patients to assess anatomical and functional connectivity. In 3 patients undergoing simultaneous intracranial electroencephalography monitoring, corticocortical evoked potentials and resting electrocorticography were used to assess electrophysiological correlates. Results All patients had generalized or multifocal seizure onsets. Three patients with preoperative evidence for possible lateralization underwent stereoelectroencephalography depth electrode implantation during the perioperative period. LITT ablation of the anterior corpus callosum was completed in a single procedure in 4 patients. One complication involving misplaced devices required a second procedure. Adequacy of the anterior callosotomy was confirmed using contrast-enhanced MRI and diffusion tensor imaging. Resting functional MRI, corticocortical evoked potentials, and resting electrocorticography demonstrated functional disconnection of the hemispheres. Postcallosotomy monitoring revealed lateralization of the seizures in all 3 patients with preoperatively suspected occult lateralization. Four of 5 patients experienced > 80% reduction in generalized seizure frequency. Two patients undergoing subsequent focal resection are free of clinical seizures at 2 years. One patient developed a 9-mm intraparenchymal hematoma at the site of entry and continued to have seizures after the procedure. Conclusions MRI-guided LITT provides an effective minimally invasive alternative method for CC in the treatment of seizures associated with drop attacks, bilaterally synchronous onset, and rapid secondary generalization. The disconnection is confirmed using anatomical and functional neuroimaging and electrophysiological measures.
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Affiliation(s)
- Kurt R Lehner
- 1Department of Neurosurgery, Hofstra Northwell School of Medicine
| | - Erin M Yeagle
- 1Department of Neurosurgery, Hofstra Northwell School of Medicine
- 2The Feinstein Institute for Medical Research; and
| | | | | | - Victor Du
- 1Department of Neurosurgery, Hofstra Northwell School of Medicine
| | | | - Sean T Hwang
- 3Department of Neurology, North Shore University Hospital, Manhasset, New York
| | - Ashesh D Mehta
- 1Department of Neurosurgery, Hofstra Northwell School of Medicine
- 2The Feinstein Institute for Medical Research; and
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Challenges in managing epilepsy associated with focal cortical dysplasia in children. Epilepsy Res 2018; 145:1-17. [DOI: 10.1016/j.eplepsyres.2018.05.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2017] [Revised: 04/30/2018] [Accepted: 05/12/2018] [Indexed: 12/15/2022]
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12
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Identification of Focal Epileptogenic Networks in Generalized Epilepsy Using Brain Functional Connectivity Analysis of Bilateral Intracranial EEG Signals. Brain Topogr 2016; 29:728-37. [DOI: 10.1007/s10548-016-0493-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Accepted: 04/19/2016] [Indexed: 10/21/2022]
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13
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Unfavorable surgical outcomes in partial epilepsy with secondary bilateral synchrony: Intracranial electroencephalography study. Epilepsy Res 2016; 122:102-9. [DOI: 10.1016/j.eplepsyres.2016.03.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2015] [Revised: 02/26/2016] [Accepted: 03/12/2016] [Indexed: 11/17/2022]
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14
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Unterberger I, Bauer R, Walser G, Bauer G. Corpus callosum and epilepsies. Seizure 2016; 37:55-60. [DOI: 10.1016/j.seizure.2016.02.012] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2015] [Revised: 02/01/2016] [Accepted: 02/25/2016] [Indexed: 11/16/2022] Open
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Dimitriadis SI. Predictive value of MEG using gradient magnetic field topography (GMFT) for seizure outcome following anterior corpus callosotomy (ACC) in patients with drop attacks. Clin Neurophysiol 2015; 127:12-14. [PMID: 26168716 DOI: 10.1016/j.clinph.2015.06.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2015] [Revised: 06/16/2015] [Accepted: 06/17/2015] [Indexed: 11/18/2022]
Affiliation(s)
- Stavros I Dimitriadis
- Institute of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, Cardiff, UK; Cardiff University Brain Research Imaging Center (CUBRIC), School of Psychology, Cardiff University, Cardiff, UK; Artificial Intelligence and Information Analysis Laboratory, Department of Informatics, Aristotle University, 54124 Thessaloniki, Greece; NeuroInformatics Group, AUTH, Thessaloniki, Greece.
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Bilateral intracranial EEG with corpus callosotomy may uncover seizure focus in nonlocalizing focal epilepsy. Seizure 2015; 24:63-9. [DOI: 10.1016/j.seizure.2014.08.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Revised: 08/20/2014] [Accepted: 08/22/2014] [Indexed: 11/20/2022] Open
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Kahilogullari G, Comert A, Ozdemir M, Brohi RA, Ozgural O, Esmer AF, Egemen N, Karahan ST. Arterial vascularization patterns of the splenium: An anatomical study. Clin Anat 2014; 26:675-81. [PMID: 23564403 DOI: 10.1002/ca.22114] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2012] [Revised: 04/24/2012] [Accepted: 05/14/2012] [Indexed: 11/07/2022]
Abstract
The aim of this study was to provide detailed information about the arterial vascularization of the splenium of the corpus callosum (CC). The splenium is unique in that it is part of the largest commissural tract in the brain and a region in which pathologies are seen frequently. An exact description of the arterial vascularization of this part of the CC remains under debate. Thirty adult human brains (60 hemispheres) were obtained from routine autopsies. Cerebral arteries were separately cannulated and injected with colored latex. Then, the brains were fixed in formaldehyde, and dissections were performed using a surgical microscope. The diameter of the arterial branches supplying the splenium of the CC at their origin was investigated, and the vascularization patterns of these branches were observed. Vascular supply to the splenium was provided by the anterior pericallosal artery (40%) from the anterior circulation and by the posterior pericallosal artery (88%) and posterior accessory pericallosal artery (50%) from the posterior circulation. The vascularization pattern of the splenium differs in each hemisphere and is usually supplied by multiple branches. The arterial vascularization of the splenium of the CC was studied comprehensively considering the ongoing debate and the inadequacy of the studies on this issue currently available in the literature. This anatomical knowledge is essential during the treatment of pathologies in this region and especially for splenial arteriovenous malformations.
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Yang PF, Lin Q, Mei Z, Chen ZQ, Zhang HJ, Pei JS, Tian J, Jia YZ, Zhong ZH. Outcome after anterior callosal section that spares the splenium in pediatric patients with drop attacks. Epilepsy Behav 2014; 36:47-52. [PMID: 24857808 DOI: 10.1016/j.yebeh.2014.04.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Revised: 04/17/2014] [Accepted: 04/21/2014] [Indexed: 11/28/2022]
Abstract
We report on the efficacy and safety of extended, one-stage anterior callosal section that spares the splenium, which is performed in a large series of pediatric patients with drop attacks. Twenty-nine pediatric patients with drop attacks were studied (19 males and 10 females; mean age: 9.9 years). As presurgical factors, the age at surgery, age at seizure onset, age at drop attack onset, sex, hemiparesis, severe mental retardation, electroencephalograph abnormalities, magnetic resonance imaging abnormalities, and (18)fluorodeoxyglucose positron emission tomography abnormalities were analyzed. All patients had multiple seizure types, including drop attacks, atypical absence seizures, complex partial seizures, tonic seizures, and generalized tonic-clonic seizures. All patients were developmentally impaired and had electroencephalograph results showing marked secondary bilateral synchrony. All patients received an extended, one-stage callosal section, leaving only the splenium intact. The mean follow-up time was 5.2 years. Seizure outcome (cessation of seizures or ≥ 90% seizure reduction) was achieved in 79.3% of patients with drop attacks. The families assessed the overall daily function as improved in 62.1% of the patients, unchanged in 24.1%, and worse in 13.8%. Family satisfaction with callosotomy was achieved in 82.8% of the patients. The majority of the patients had some degree of a transient acute postoperative disconnection syndrome that disappeared within 3 weeks. Postoperatively, patients showed a consistent increase in attention levels. We conclude that extended callosal sectioning that leaves the splenium intact should be considered a good palliative surgical option for pediatric patients with drop attacks and that diminishment of epileptic discharge synchrony is a good prognostic sign following callosotomy. We also found that the postoperative increase in attention levels was as useful as seizure control in improving the quality of life of these patients.
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Affiliation(s)
- Peng-Fan Yang
- Department of Neurosurgery, Fuzhou General Hospital of Nanjing Command, PLA, Fuzhou 350025, China.
| | - Qiao Lin
- Department of Epileptology, Fuzhou General Hospital of Nanjing Command, PLA, Fuzhou 350025, China
| | - Zhen Mei
- Department of Epileptology, Fuzhou General Hospital of Nanjing Command, PLA, Fuzhou 350025, China
| | - Zi-Qian Chen
- Department of Medical Imaging, Fuzhou General Hospital of Nanjing Command, PLA, Fuzhou 350025, China
| | - Hui-Jian Zhang
- Department of Neurosurgery, Fuzhou General Hospital of Nanjing Command, PLA, Fuzhou 350025, China
| | - Jia-Sheng Pei
- Department of Neurosurgery, Fuzhou General Hospital of Nanjing Command, PLA, Fuzhou 350025, China
| | - Jun Tian
- Department of Neurosurgery, Fuzhou General Hospital of Nanjing Command, PLA, Fuzhou 350025, China
| | - Yan-Zeng Jia
- Department of Epileptology, Fuzhou General Hospital of Nanjing Command, PLA, Fuzhou 350025, China
| | - Zhong-Hui Zhong
- Department of Epileptology, Fuzhou General Hospital of Nanjing Command, PLA, Fuzhou 350025, China
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Bauer G, Płonka-Półtorak E, Bauer R, Unterberger I, Kuchukhidze G. Corpus callosum and epilepsies. JOURNAL OF EPILEPTOLOGY 2013. [DOI: 10.1515/joepi-2015-0008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
SUMMARYIntroduction.Corpus callosum (CC) is the largest forebrain commissure. Structural anomalies and accompanying clinical symptoms are not in the focus of neurologists, epileptologists or neurosurgeons.Aim and method.Anatomy, embryological development, normal functions, structural abnormalities, additional malformations, clinical symptoms and seizure disorders with CC anomalies are reviewed from the literature.Review.The detection of callosal anomalies increased rapidly with widespread use of brain imaging methods. Agenesis or dysgenesis of corpus callosum (AgCC) might be considered an accidental finding. Epileptic seizures occur in up to 89% of patients with AgCC. The causal relationship correctly is questioned. However, additional causative malformations of midline and/or telencephalic structures can be demonstrated in most seizure patients. The interruption of bilateral spread of seizure activities acts as the concept for callosotomy as epilepsy surgery. Indications are drug-resistant generalized, diffuse, or multifocal epilepsies. A resectable seizure onset zone should be excluded. Most treated patients are diagnosed as Lennox-Gastaut or Lennox-like syndrome.Conclusions.In cases with callosal abnormalities and clinical symptoms additional malformations are frequently observed, especially with seizure disorders. Callosotomy is the most effective option against drop attacks. The method probably is underused. After callosotomy a circumscript seizure focus might be unveiled and a second step of resective epilepsy surgery can be successful.
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Okumura E, Iwasaki M, Sakuraba R, Itabashi I, Osawa SI, Jin K, Itabashi H, Kato K, Kanno A, Tominaga T, Nakasato N. Time-varying inter-hemispheric coherence during corpus callosotomy. Clin Neurophysiol 2013; 124:2091-100. [DOI: 10.1016/j.clinph.2013.05.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2013] [Revised: 04/28/2013] [Accepted: 05/14/2013] [Indexed: 10/26/2022]
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Early total corpus callosotomy in a patient with cryptogenic West syndrome. Seizure 2013; 22:320-3. [PMID: 23375871 DOI: 10.1016/j.seizure.2013.01.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2012] [Revised: 01/09/2013] [Accepted: 01/11/2013] [Indexed: 11/23/2022] Open
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[Resection of frontal lobe epileptogenic foci identified after corpus callosotomy: long term results]. Neurocirugia (Astur) 2013; 24:57-62. [PMID: 23294806 DOI: 10.1016/j.neucir.2012.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2012] [Revised: 10/04/2012] [Accepted: 10/18/2012] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To analyse the results of resective surgery in patients in whom it was possible to identify a frontal epileptogenic focus through corpus callosotomy. MATERIAL AND METHODS Data from patients suffering drug-resistant epilepsy showing persistence of disabling seizures after undergoing corpus callosotomy and subsequent treatment with frontal lobe resective surgery were prospectively reviewed. Classifications according to Engel's scale before and after each intervention were evaluated, as were the percentages of seizure reduction. Additionally, the satisfaction of family members with surgical outcomes was also assessed. RESULTS Eleven patients were identified. After a median follow-up period of 7 years (IQR: 3-8 years), 63.6% of patients showed improvement of seizures according to Engel's scale, 27.2% remained unchanged and one worsened. One patient was categorised as class i, 8 as class ii, one as class iii and one as class iv. The percentage reduction in the number of seizures was over 90% in 54.5% of patients, between 50% and 90% in 36.4% and less than 50% in 9.1%. Family satisfaction was reported as good or excellent in 90.9% of cases. CONCLUSIONS In addition to providing better seizure control, corpus callosotomy also appears to be a diagnostic tool allowing the identification of potential targets for resective surgery. Therefore, it should be considered upon suspicion of a frontal epileptogenic focus which could be surgically treated.
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Greiner HM, Tillema JM, Hallinan BE, Holland K, Lee KH, Crone KR. Corpus callosotomy for treatment of pediatric refractory status epilepticus. Seizure 2012; 21:307-9. [PMID: 22326839 DOI: 10.1016/j.seizure.2012.01.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2011] [Revised: 01/20/2012] [Accepted: 01/21/2012] [Indexed: 10/14/2022] Open
Abstract
Medically refractory status epilepticus (RSE) causes high morbidity and mortality in children. There are no evidence-based guidelines for treatment. Epilepsy surgery is a treatment option for RSE. We describe a 9-year-old boy treated successfully for RSE with complete corpus callosotomy (CC). Epilepsy surgery should be considered for prolonged RSE. In the absence of evidence of focal epileptogenesis, complete corpus callosotomy may be effective in select cases.
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Affiliation(s)
- Hansel M Greiner
- Department of Pediatrics, Division of Child Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA.
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Iwasaki M, Nakasato N, Kakisaka Y, Kanno A, Uematsu M, Haginoya K, Tominaga T. Lateralization of interictal spikes after corpus callosotomy. Clin Neurophysiol 2011; 122:2121-7. [DOI: 10.1016/j.clinph.2011.04.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2011] [Revised: 04/14/2011] [Accepted: 04/16/2011] [Indexed: 10/18/2022]
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Hur YJ, Kang HC, Kim DS, Choi SR, Kim HD, Lee JS. Uncovered primary seizure foci in Lennox-Gastaut syndrome after corpus callosotomy. Brain Dev 2011; 33:672-7. [PMID: 21146944 DOI: 10.1016/j.braindev.2010.11.005] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2010] [Revised: 11/08/2010] [Accepted: 11/10/2010] [Indexed: 11/29/2022]
Abstract
PURPOSE Corpus callosotomy (CC) is a palliative surgical procedure to control atonic, tonic, or generalized tonic-clonic seizure in Lennox-Gastaut syndrome (LGS). Here, we report patients with LGS who underwent resective surgery, following CC better delineating the presumed seizure foci localized in one hemisphere. METHODS We retrospectively reviewed seven patients with LGS who underwent CC and subsequent cortical resection. The median follow-up duration after lobectomy was 20 months (range, 15-54 months) and three patients had follow-up periods over 24 months. The findings of video electroencephalography (EEG) monitoring, structural and functional neuroimagings were compared between pre- and post-CC. RESULTS Four patients had Engel class I and one patient had Engel class II outcomes following cortical resection; post-CC, compared to pre-CC, showed better localized ictal/interictal epileptiform discharges in the unilateral frontal area in two patients, in the unilateral parieto-temporo-occipital areas in one patient and in the unilateral fronto-temporal areas in the remaining two patients. Two patients had Engel Class III outcome following cortical resection; post-CC EEG continued to show multifocal epileptiform discharges but predominantly arising from a unilateral frontal area. Following CC, positron emission tomography showed localized glucose hypometabolism of which location was concordant with post-CC EEG abnormalities in all patient. Similarly, ictal/interictal single photon emission computed tomography also showed localized abnormalities concordant with post-CC EEG abnormalities in five of the six patients. Pathological assessment revealed cortical dysplasia in six patients, whereas no pathological abnormality was found in the remaining patient, who obtained Engel Class I outcome following cortical resection. CONCLUSION CC could change EEG findings, glucose metabolisms and cerebral blood flows, and it is sometimes helpful in delineating the primary seizure focus in patients with LGS.
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Affiliation(s)
- Yun Jung Hur
- Department of Pediatrics, Haeundae Paik Hospital, Inje University College of Medicine, Pusan, Republic of Korea
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Lin JS, Lew SM, Marcuccilli CJ, Mueller WM, Matthews AE, Koop JI, Zupanc ML. Corpus callosotomy in multistage epilepsy surgery in the pediatric population. J Neurosurg Pediatr 2011; 7:189-200. [PMID: 21284466 DOI: 10.3171/2010.11.peds10334] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT The object of this study was to evaluate surgical outcome in a select group of patients with medically refractory epilepsy who had undergone corpus callosotomy combined with bilateral subdural electroencephalography (EEG) electrode placement as the initial step in multistage epilepsy surgery. METHODS A retrospective chart review of 18 children (ages 3.5-18 years) with medically refractory symptomatic generalized or localization-related epilepsy was undertaken. A corpus callosotomy with subdural bihemispheric EEG electrode placement was performed as the initial step in multistage epilepsy surgery. All of the patients had tonic and atonic seizures; 6 patients also experienced complex partial seizures. All of the patients had frequent generalized epileptiform discharges as well as multifocal independent epileptiform discharges on surface EEG monitoring. Most of the patients (94%) had either normal (44%) MR imaging studies of the brain or bihemispheric abnormalities (50%). One patient had a suspected unilateral lesion (prominent sylvian fissure). RESULTS Of the 18 patients who underwent corpus callosotomy and placement of subdural strips and grids, 12 progressed to further resection based on localizing data obtained during invasive EEG monitoring. The mean patient age was 10.9 years. The duration of invasive monitoring ranged from 3 to 14 days, and the follow-up ranged from 6 to 70 months (mean 35 months). Six (50%) of the 12 patients who had undergone resection had an excellent outcome (Engel Class I or II). There were no permanent neurological deficits or deaths. CONCLUSIONS The addition of invasive monitoring for patients undergoing corpus callosotomy for medically refractory epilepsy may lead to the localization of surgically amenable seizure foci, targeted resections, and improved seizure outcomes in a select group of patients typically believed to be candidates for palliative surgery alone.
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Affiliation(s)
- Jessica S Lin
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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Callosotomy and subsequent surgery for children with refractory epilepsy. Epilepsy Res 2011; 93:185-91. [DOI: 10.1016/j.eplepsyres.2010.12.011] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2010] [Revised: 12/15/2010] [Accepted: 12/21/2010] [Indexed: 11/29/2022]
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Silverberg A, Parker-Menzer K, Devinsky O, Doyle W, Carlson C. Bilateral intracranial electroencephalographic monitoring immediately following corpus callosotomy. Epilepsia 2010; 51:2203-6. [DOI: 10.1111/j.1528-1167.2010.02568.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Ping Z, Ji-Wen X, Gui-Song W, Hong-Yu Z, Xin T. Evaluation of efficacy and safety of anterior corpus callosotomy with keyhole in refractory seizures. Seizure 2009; 18:417-9. [PMID: 19410486 DOI: 10.1016/j.seizure.2009.03.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2008] [Revised: 03/13/2009] [Accepted: 03/20/2009] [Indexed: 11/30/2022] Open
Abstract
PURPOSE This study was conducted to evaluate the efficacy and safety of anterior corpus callosotomy with a keyhole approach on refractory seizures and to evaluate this procedure for drop attacks (DAs) and generalized tonic-clonic seizures (GTCSs). METHODS All refractory seizure patients underwent anterior corpus callosotomy (n=31) without other epilepsy surgery. Seizure response and procedure complications were evaluated. RESULTS Seizure types included GTCS (n=26), and atonic or tonic seizures with DA (n=9). In GTCS patients, 84.6% had >or=50% decrease in seizure frequency, and 61.5% had >or=80% reduction. In DA patients, 77.8% had >or=50% decrease in seizure frequency, and 55.6% had >or=80% reduction. There were no statistically significant differences between the groups in final efficacy. Overall complication rate for corpus callosotomy was 12.9%, the permanent complication rate was 3.2%. CONCLUSIONS Anterior corpus callosotomy with a keyhole approach produces highly favorable outcomes for both GTCS and atonic or tonic seizures with a low risk for complications.
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Affiliation(s)
- Zheng Ping
- Department of Neurosurgery, Renji Hospital, Shanghai Jiaotong University, School of Medicine, Shanghai, China
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Abstract
Corpus callosotomy is a palliative surgical procedure that is suitable for some patients with intractable seizures who are not candidates for focal resective surgery. The rationale for this procedure is based on the hypothesis that the corpus callosum is a critical pathway for interhemispheric spread of epileptic activity. Efficacy and relatively low permanent morbidity in corpus callosotomy for medically intractable epilepsy have been demonstrated by more than six decades of experience. Callosotomy best ameliorates drop attacks (tonic and atonic seizures), though tonic-clonic, absence, and frontal lobe complex partial seizures often respond as well. In addition to seizure reduction, behavior and quality of life may improve. Hence, callosotomy is justified as a therapy for appropriate patients with intractable epilepsy.
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Kahilogullari G, Comert A, Arslan M, Esmer AF, Tuccar E, Elhan A, Tubbs RS, Ugur HC. Callosal branches of the anterior cerebral artery: an anatomical report. Clin Anat 2008; 21:383-8. [PMID: 18521950 DOI: 10.1002/ca.20647] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Although the morphology of the corpus callosum is well defined, the arterial supply of this structure has not been comprehensively studied. To elucidate this further, 40 cerebral hemispheres from 30 adult cadaveric brains were obtained. The anterior cerebral arteries were cannulated and injected with red latex. The following were observed and documented: (1) the number, diameter, and course of the arteries supplying the corpus callosum; (2) the territories vascularized by these arteries; (3) any variations of the callosal arteries. Short callosal arteries were present in 58 hemispheres (96.6%) and supplied the superficial surface of the corpus callosum along its midline and were a primary arterial source to this structure. Long callosal arteries were found in 28 hemispheres (46.6%) and contributed to the pial plexus. The cingulocallosal arteries were present in all hemispheres and supplied the corpus callosum, cingulate gyrus, and also contributed to the pericallosal pial plexus. The recurrent cingulocallosal arteries were present in 17 hemispheres (28.3%) and also contributed to the pericallosal pial plexus. The median callosal artery, an anatomical variation, was present in 10 brains (33.3%). This vessel supplied the corpus callosum and the cingulate gyrus. The aim of the present study was to provide a detailed description of the arteries supplying the corpus callosum for those who encounter these vessels radiologically or surgically.
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Affiliation(s)
- G Kahilogullari
- Department of Neurosurgery, Ankara University, Faculty of Medicine, Ankara, Turkey
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