Abstracts

Rationale: To determine the safety and effectiveness of stereotactic laser anterior corpus callosotomy (SLACC) in patients with Lennox-Gastaut Syndrome (LGS). Methods: We reviewed sequential cases of patients with medically intractable LGS who underwent SLACC using a two-probe technique between November 2014 and November 2018. Pre- and post-operative MRIs including diffusion tensor imaging (DTI) were used to assess the volume and anterio-posterior length of callosal ablation (contrast-enhancing lesion) and disconnection (loss of fractional anisotropy). Patients were followed postoperatively in clinic to assess clinical outcomes. Results: Nine patients were included in this study. The mean duration of epilepsy was 32±14 years; mean age was 26±11 years; mean duration of postoperative follow was 16±11 months. Percent of corpus callosum ablated was 23±5% by volume and 58±4% by length. Percent of corpus callosum disconnected was 71±10% by volume and 72±7% by length. Of the 9 patients, one (11%) became seizure free and a second patient (11%) became seizure free after undergoing a second ablation to achieve a complete corpus callosotomy. Six (67%) patients achieved >70% of seizure reduction, four of whom (44%) became free of drop attacks. Three (33%) patients achieved modest improvement initially, but the frequency of seizures and drop attacks returned to that of pre-ablation baseline after 6 months. One patient had an asymptomatic intra-parenchymal hemorrhage along the fiber tract. One patient developed significant aggression after becoming seizure free. Narcotics were not required for pain control in any of the patients. The mean duration of postoperative hospital stay was 2 days. Conclusions: These findings demonstrate the safety of SLACC with similar seizure outcomes to that of open anterior corpus callosotomy in patients with LGS. SLACC might be a safe and effective alternative to traditional open anterior corpus callosotomy with less post-operative pain, shorter hospital stays and lower morbidity by avoiding a craniotomy and frontal lobe retraction. Funding: No funding