A Multi-institutional Comparison of Contemporary Surgical Approaches and Outcomes of Corpus Callosotomy
Abstract number :
2.291
Submission category :
9. Surgery / 9B. Pediatrics
Year :
2022
Submission ID :
2204453
Source :
www.aesnet.org
Presentation date :
12/4/2022 12:00:00 PM
Published date :
Nov 22, 2022, 05:25 AM
Authors :
Daniel Hansen, MD – Cook Children's Medical Center; sabrina Shandley, PhD – Cook Children's Medical Center; Cynthia Keator, MD – Cook Children's Medical Center; M. Scott Perry, MD – Cook Children's Medical Center; Allyson Alexander, MD – Children’s Hospital Colorado; Krista Eschbach, MD – Children’s Hospital Colorado; Michael Ciliberto, MD – University of Iowa; Dewi Depositario-Cabacar, MD – Children’s National; Zach Grinspan, MD – Weill Cornell Medicine; B. Oyinkan Marquis, MD – Weill Cornell Medicine; Srishti Nangia, MD – Weill Cornell Medicine; Samir Karia, MD – University of Louisville; Chad Manuel, MD – Vanderbilt University Medical Center; Michael McCormack, MD – Vanderbilt University Medical Center; Shilpa Reddy, MD – Vanderbilt University Medical Center; Nancy McNamara, MD – CS Mott Children's Hospital; Erin Romanowski, MD – CS Mott Children's Hospital; Joffre Olaya, MD – Children’s Hospital Orange County; Adam Ostendorf, MD – Nationwide Children's Hospital; Ernesto Gonzalez-Giraldo, MD – University of California-San Francisco; Joseph Sullivan, MD – University of California-San Francisco; Rani Singh, MD – Atrium Health; Priya Tatachar, MD – Lurie Children's Hospital; Lily Wong-Kisiel, MD – Mayo Clinic
Rationale: Corpus callosotomy (CC) is an established palliative epilepsy surgery commonly performed via open craniotomy. Advances in surgical technique have led to less-invasive methods to perform CC including endoscopic/mini-craniotomy and laser interstitial thermal therapy (LITT) disconnection. Little is known about how these methods compare to traditional open procedures.
Methods: The Pediatric Epilepsy Research Consortium Epilepsy Surgery Database is a prospective observational study collecting data on all children 0 to 18 years referred for surgery across 24 U.S. pediatric epilepsy centers. For this analysis, we included patients undergoing corpus callosotomy for treatment of drug resistant epilepsy. Descriptive analysis of the cohort was followed by comparison of operative variables and outcome between surgical methods using analysis of variance. Engel outcome was reported for all seizure types at last follow up.
Results: A total of 83 patients underwent 85 procedures at 14 participating hospitals. Baseline characteristics of the cohort are presented in Table 1. Complications occurred in 12 (14%) including wound breakdown, temporary weakness, respiratory distress, feeding difficulties and post-surgery hydrocephalus. Complications were more common in open and endoscopic procedures compared to LITT. Outcome was available for 82 procedures with a mean duration of 13.3 months follow up (range, 1-90, SD = 13.1). 60 (72%) patients reported Engel Class I-III outcomes, 14 (17%) were seizure free at last follow up. Surgical variables are reported in Table 2 with several statistically significant differences noted. Endoscopic/minimally invasive approaches had operative times nearly 50% shorter compared to LITT and open procedures. Both LITT and endoscopic approaches showed less operative blood loss, but this did not lead to significant difference in rates of blood transfusion. Only open procedures had re-admissions. While not reaching statistical significance, there appears to be a clinically important gradient in achieving Engel 1-3 outcomes with open procedures most successful (79%) followed by endoscopic (68%) and LITT (59%).
Conclusions: Corpus callosotomy is an effective palliative procedure resulting in >50% seizure reduction in most patients of whom some will achieve seizure freedom. Open procedures may have better efficacy compared to less invasive approaches, with LITT the least efficacious. A statistical difference was not observed likely secondary to small sample size. The benefit of improved efficacy should be weighed against other factors. LITT requires longer operative time, but is associated with fewer complications, less blood loss, and lower readmission rates, particularly compared to open procedures. The endoscopic/mini-craniotomy approach offers the shortest operative time with similar advantages to LITT compared against open procedures. These differences should be taken into consideration when discussing surgical options with patients and their families.
Funding: None
Surgery