Surgical outcomes of open and laser interstitial thermal therapy approaches for corpus callosotomy in pediatric epilepsy

Abstract

ObjectiveCorpus callosotomy (CC) is a palliative surgical intervention for patients with medically refractory epilepsy that has evolved in recent years to include a less‐invasive alternative with the use of laser interstitial thermal therapy (LITT). LITT works by heating a stereotactically placed laser fiber to ablative temperatures under real‐time magnetic resonance imaging (MRI) thermometry. This study aims to (1) describe the surgical outcomes of CC in a large cohort of children with medically refractory epilepsy, (2) compare anterior and complete CC, and (3) review LITT as a surgical alternative to open craniotomy for CC.MethodsThis retrospective cohort study included 103 patients <21 years of age with at least 1 year follow‐up at a single institution between 2003 and 2021. Surgical outcomes and the comparative effectiveness of anterior vs complete and open versus LITT surgical approaches were assessed.ResultsCC was the most common surgical disconnection (65%, n = 67) followed by anterior two‐thirds (35%, n = 36), with a portion proceeding to posterior completion (28%, n = 10). The overall surgical complication rate was 6% (n = 6/103). Open craniotomy was the most common approach (87%, n = 90), with LITT used increasingly in recent years (13%, n = 13). Compared to open, LITT had shorter hospital stay (3 days [interquartile range (IQR) 2–5] vs 5 days [IQR 3–7]; p < .05). Modified Engel class I, II, III, and IV outcomes at last follow‐up were 19.8% (n = 17/86), 19.8% (n = 17/86), 40.2% (n = 35/86), and 19.8% (n = 17/86). Of the 70 patients with preoperative drop seizures, 75% resolved postoperatively (n = 52/69).SignificanceNo significant differences in seizure outcome between patients who underwent only anterior CC and complete CC were observed. LITT is a less‐invasive surgical alternative to open craniotomy for CC, associated with similar seizure outcomes, lower blood loss, shorter hospital stays, and lower complication rates, but with longer operative times, when compared with the open craniotomy approach.

The changing landscape of palliative epilepsy surgery for Lennox Gastaut Syndrome

“…For example, preliminary data suggests that neuromodulation via DBS or RNS may be more effective than VNS ( 6 ), yet patients and families are often hesitant to consider an intracranial neurosurgery operation over traditional VNS. Similarly, open microsurgical CC is a well-established method for reducing drop attack seizures, but there is now also the option of less invasive CC ablation which avoids the potential complications of craniotomy and decreases length of hospitalization for patients ( 7 ). However, this approach is still relatively novel and high-quality evidence demonstrating its noninferiority to CC is not yet available ( 8 ).…”