Kasasbeh Aimen S, Smyth Matthew D, Steger-May Karen, Jalilian Laleh, Bertrand Mary, Limbrick David D
*Neural Engineering Laboratory, Mayo Clinic, Rochester, Minnesota; Departments of ‡Neurological Surgery, and §Neurology, St. Louis Children's Hospital, Washington University in St. Louis, St. Louis, Missouri; ¶Division of Biostatistics, Washington University School of Medicine in St. Louis, St. Louis, Missouri.
Neurosurgery. 2014 Jan;74(1):17-28; discussion 28. doi: 10.1227/NEU.0000000000000197.
Corpus callosotomy (CC) is a valuable palliative surgical option for children with medically refractory epilepsy due to generalized or multifocal cortical seizure onset.
To investigate the extent of CC resulting in optimal seizure control in a pediatric patient population and to evaluate the modification of seizure profile after various CC approaches.
The records of 58 children (3-22 years of age at the time of surgery) with medically refractory epilepsy who underwent CC between 1995 and 2011 were retrospectively reviewed.
Anterior two thirds callosotomy resulted in resolution of absence (P = .03) and astatic (P = .03) seizures, whereas anterior two thirds callosotomy followed by second-stage completion resulted in resolution of generalized tonic-clonic (GTC) (P = .03), astatic (P = .005), and myoclonic (P = .03) seizures in addition to a trend toward resolution of absence seizures (P = .08). Single-stage upfront complete callosotomy resulted in resolution of absence (P = .002), astatic (P < .0001), myoclonic (P = .007), and complex partial (P = .008) seizures in addition to a trend toward resolution of GTC (P = .06). In comparing a composite of subjects who underwent anterior two thirds callosotomy alone or 2-stage complete callosotomy before the second stage to complete the callosotomy with subjects who underwent upfront complete CC, a more favorable outcome was found in those with the upfront complete CC (P = .02).
Single-stage upfront complete callosotomy is effective in relieving a broader spectrum of seizure types than anterior two thirds callosotomy or 2-stage complete callosotomy in children. The advantages of single-stage complete callosotomy must be weighed against the potentially higher risk of neurological and operative complications.
胼胝体切开术（CC）是一种对因全身性或多灶性皮质癫痫发作而药物难治性癫痫患儿有价值的姑息性手术选择。
研究在儿科患者群体中能实现最佳癫痫控制的胼胝体切开术范围，并评估各种胼胝体切开术方法后癫痫发作类型的改变。
回顾性分析1995年至2011年间接受CC手术的58例药物难治性癫痫患儿（手术时年龄3至22岁）的记录。
前三分之二胼胝体切开术可使失神发作（P = 0.03）和无动性发作（P = 0.03）得到缓解，而前三分之二胼胝体切开术加二期完成手术可使全身性强直阵挛发作（GTC）（P = 0.03）、无动性发作（P = 0.005）和肌阵挛发作（P = 0.03）得到缓解，失神发作缓解也有一定趋势（P = 0.08）。一期一次性完全胼胝体切开术除了使GTC发作缓解有一定趋势（P = 0.06）外，还可使失神发作（P = 0.002）、无动性发作（P < 0.0001）、肌阵挛发作（P = 0.007）和复杂部分性发作（P = 0.008）得到缓解。将仅接受前三分之二胼胝体切开术或二期完全胼胝体切开术二期前完成手术的患者与接受一次性完全胼胝体切开术的患者进行综合比较，发现一次性完全胼胝体切开术患者的预后更有利（P = 0.02）。
在儿童中，一期一次性完全胼胝体切开术比前三分之二胼胝体切开术或二期完全胼胝体切开术能更有效地缓解更广泛类型的癫痫发作。必须权衡一期完全胼胝体切开术的优势与潜在更高的神经和手术并发症风险。
