Department of Neurosurgery, XuanWu Hospital, Capital Medical University, Beijing, China.
International Neuroscience Institute (China-INI), Beijing, China.
Brain Behav. 2023 Apr;13(4):e2964. doi: 10.1002/brb3.2964. Epub 2023 Mar 16.
Corpus callosotomy (CC) is appropriate for patients with seizures of a bilateral or diffuse origin, or those with seizures of a unilateral origin with rapid spread to the contralateral cerebral hemisphere. The efficiency of CC in patients with drug-resistant epilepsy is a long-term concern because most articles reporting the surgical results of CC arise from small case series, and the durations of follow-up vary.
PubMed, Embase, Cochrane Library, and Web of Science were searched to identify papers published before November 8, 2021. The systematic review was completed following PRISMA guidelines. Outcomes were analyzed by meta-analysis of the proportions.
A total of 1644 patients with drug-resistant epilepsy (49 retrospective or prospective case series studies) underwent CC, and the follow-up time of all patients was at least 1 year. The rate of complete seizure freedom (SF) was 12.38% (95% confidence interval [CI], 8.17%-17.21%). Meanwhile, the rate of complete SF from drop attacks was 61.86% (95% CI, 51.87%-71.41%). The rates of complete SF after total corpus callosotomy (TCC) and anterior corpus callosotomy (ACC) were 11.41% (95% CI, 5.33%-18.91%) and 6.75% (95% CI, 2.76%-11.85%), respectively. Additionally, the rate of complete SF from drop attacks after TCC was significantly higher than that after ACC (71.52%, 95% CI, 54.22%-86.35% vs. 57.11%, 95% CI, 42.17%-71.49%). The quality of evidence for the three outcomes by GRADE assessment was low to moderate.
There was no significant difference in the rate of complete SF between TCC and ACC. TCC had a significantly higher rate of complete SF from drop attacks than did ACC. Furthermore, CC for the treatment of drug-resistant epilepsy remains an important problem for further investigation because there are no universally accepted standardized guidelines for the extent of CC and its benefit to patients. In future research, we will focus on this issue.
胼胝体切开术（CC）适用于起源于双侧或弥漫性、或起源于单侧但迅速扩散至对侧大脑半球的癫痫患者。CC 对耐药性癫痫患者的疗效是一个长期关注的问题，因为大多数报道 CC 手术结果的文章来自小的病例系列，且随访时间长短不一。
检索了 PubMed、Embase、Cochrane 图书馆和 Web of Science，以确定 2021 年 11 月 8 日前发表的论文。系统评价按照 PRISMA 指南进行。通过比例的荟萃分析来分析结果。
共有 1644 例耐药性癫痫患者（49 项回顾性或前瞻性病例系列研究）接受了 CC 治疗，所有患者的随访时间至少为 1 年。完全无癫痫发作（SF）率为 12.38%（95%置信区间 [CI]，8.17%-17.21%）。同时，完全无癫痫发作伴跌倒发作的比例为 61.86%（95% CI，51.87%-71.41%）。全胼胝体切开术（TCC）和前胼胝体切开术（ACC）后的完全 SF 率分别为 11.41%（95% CI，5.33%-18.91%）和 6.75%（95% CI，2.76%-11.85%）。此外，TCC 后完全无癫痫发作伴跌倒发作的比例明显高于 ACC（71.52%，95% CI，54.22%-86.35% vs. 57.11%，95% CI，42.17%-71.49%）。GRADE 评估对这三个结果的证据质量为低到中度。
TCC 和 ACC 之间完全 SF 率无显著差异。TCC 完全无癫痫发作伴跌倒发作的比例明显高于 ACC。此外，CC 治疗耐药性癫痫仍然是一个需要进一步研究的重要问题，因为目前没有普遍接受的胼胝体切开术范围及其对患者益处的标准化指南。在未来的研究中，我们将关注这个问题。
