Jalilian Laleh, Limbrick David D, Steger-May Karen, Johnston Jim, Powers Alex K, Smyth Matthew D
Washington University in St. Louis School of Medicine, St. Louis, Missouri 63110-1077, USA.
J Neurosurg Pediatr. 2010 Sep;6(3):257-66. doi: 10.3171/2010.5.PEDS1029.
The goal of this study was to evaluate the efficacy of anterior versus complete sectioning of the corpus callosum in children suffering from medically refractory epilepsy. The authors report seizure outcome in patients who underwent anterior two-thirds or complete corpus callosotomy (CC) during the period 1995-2008 at St. Louis Children's Hospital.
The medical records of 27 children and adolescents with a minimum follow-up of 6 months were retrospectively evaluated with respect to seizure status, anticonvulsant outcomes, and subjective results. Preoperatively, patients suffered from a variety of seizure types that occurred daily, weekly, or episodically. The male/female ratio was 19:8, and patients ranged in age between 3 and 19 years (mean 9.93 years). Seizure outcome, parental assessment of daily function, and changes in the number of prescribed antiepileptic drugs were all assessed.
Fifteen patients underwent an initial anterior two-thirds CC, and 12 underwent a complete CC. Of the 15 patients who underwent an anterior CC, 7 went on to receive a posterior CC. Seizure control was superior in children undergoing a complete CC (91%, Class I-III) versus an anterior two-thirds CC (75%, Class I-III). Seizure types most affected by CC included atonic, myoclonic, and absence. The number of postoperative antiepileptic drugs did not significantly change following CC in either the anterior only or complete groups. One patient experienced a transient disconnection syndrome that resolved within 4 weeks, and 4 patients experienced mild hemiparesis and speech delays that resolved with therapy. Three patients experienced surgical complications requiring a second operation. The overall daily function and attentiveness of the patients improved.
A complete CC should be considered as the initial procedure in lower-functioning children afflicted by absence, atonic, or myoclonic seizures. Severely affected higher-functioning children may also benefit from a complete CC, without clinically significant disconnection syndromes. A completion posterior CC may benefit patients in whom a prior anterior CC has failed.
本研究的目的是评估胼胝体前部切开术与完全切开术对药物难治性癫痫患儿的疗效。作者报告了1995年至2008年期间在圣路易斯儿童医院接受三分之二胼胝体前部切开术或完全胼胝体切开术（CC）的患者的癫痫发作结果。
对27例儿童和青少年的医疗记录进行回顾性评估，这些患者的最短随访时间为6个月，评估内容包括癫痫发作状态、抗惊厥药物疗效和主观结果。术前，患者患有各种类型的癫痫发作，发作频率为每日、每周或偶尔发作。男女比例为19:8，患者年龄在3至19岁之间（平均9.93岁）。评估癫痫发作结果、家长对日常功能的评估以及抗癫痫药物处方数量的变化。
15例患者接受了初次三分之二胼胝体前部切开术，12例接受了完全胼胝体切开术。在接受三分之二胼胝体前部切开术的15例患者中，7例随后接受了后部胼胝体切开术。接受完全胼胝体切开术的儿童癫痫控制情况优于接受三分之二胼胝体前部切开术的儿童（91%，I-III级）对（75%，I-III级）。受胼胝体切开术影响最大的癫痫发作类型包括失张力性、肌阵挛性和失神发作。仅行前部切开术或完全切开术的患者在胼胝体切开术后抗癫痫药物的数量均未显著改变。1例患者出现短暂性分离综合征，4周内缓解，4例患者出现轻度偏瘫和言语延迟，经治疗后缓解。3例患者出现手术并发症，需要再次手术。患者的整体日常功能和注意力有所改善。
对于患有失神、失张力或肌阵挛性癫痫发作的低功能儿童，应考虑将完全胼胝体切开术作为初始治疗方法。严重受影响的高功能儿童也可能从完全胼胝体切开术中获益，且无明显的临床分离综合征。对于先前三分之二胼胝体前部切开术失败的患者，后部胼胝体切开术可能有益。
