Department of Neurosurgery, Washington University in St. Louis, St. Louis, Missouri, USA.
Division of Pediatric Neurosurgery, Johns Hopkins All Children's Hospital, St. Petersburg, Florida, USA.
Epilepsia. 2023 Sep;64(9):2274-2285. doi: 10.1111/epi.17679. Epub 2023 Jun 28.
OBJECTIVE: Corpus callosotomy (CC) is a palliative surgical intervention for patients with medically refractory epilepsy that has evolved in recent years to include a less-invasive alternative with the use of laser interstitial thermal therapy (LITT). LITT works by heating a stereotactically placed laser fiber to ablative temperatures under real-time magnetic resonance imaging (MRI) thermometry. This study aims to (1) describe the surgical outcomes of CC in a large cohort of children with medically refractory epilepsy, (2) compare anterior and complete CC, and (3) review LITT as a surgical alternative to open craniotomy for CC. METHODS: This retrospective cohort study included 103 patients <21 years of age with at least 1 year follow-up at a single institution between 2003 and 2021. Surgical outcomes and the comparative effectiveness of anterior vs complete and open versus LITT surgical approaches were assessed. RESULTS: CC was the most common surgical disconnection (65%, n = 67) followed by anterior two-thirds (35%, n = 36), with a portion proceeding to posterior completion (28%, n = 10). The overall surgical complication rate was 6% (n = 6/103). Open craniotomy was the most common approach (87%, n = 90), with LITT used increasingly in recent years (13%, n = 13). Compared to open, LITT had shorter hospital stay (3 days [interquartile range (IQR) 2-5] vs 5 days [IQR 3-7]; p < .05). Modified Engel class I, II, III, and IV outcomes at last follow-up were 19.8% (n = 17/86), 19.8% (n = 17/86), 40.2% (n = 35/86), and 19.8% (n = 17/86). Of the 70 patients with preoperative drop seizures, 75% resolved postoperatively (n = 52/69). SIGNIFICANCE: No significant differences in seizure outcome between patients who underwent only anterior CC and complete CC were observed. LITT is a less-invasive surgical alternative to open craniotomy for CC, associated with similar seizure outcomes, lower blood loss, shorter hospital stays, and lower complication rates, but with longer operative times, when compared with the open craniotomy approach.
目的：胼胝体切开术（CC）是一种针对药物难治性癫痫患者的姑息性手术干预措施，近年来已发展为一种使用激光间质热疗（LITT）的微创替代方法。LITT 通过在实时磁共振成像（MRI）测温下将立体定向放置的激光纤维加热到消融温度来工作。本研究旨在：（1）描述在一家机构中对大量药物难治性癫痫儿童进行 CC 的手术结果；（2）比较前切与全切 CC；（3）回顾 LITT 作为 CC 开颅术的替代方法。
方法：这是一项回顾性队列研究，纳入了 2003 年至 2021 年期间在一家机构接受至少 1 年随访的 103 名年龄<21 岁的患者。评估了手术结果以及前切与全切和开颅与 LITT 手术方法的比较效果。
结果：CC 是最常见的手术分离方法（65%，n=67），其次是前 2/3（35%，n=36），部分患者进行后部完成（28%，n=10）。总体手术并发症发生率为 6%（n=6/103）。开颅术是最常见的方法（87%，n=90），近年来 LITT 的应用越来越多（13%，n=13）。与开颅相比，LITT 的住院时间更短（3 天[四分位距（IQR）2-5] vs 5 天[IQR 3-7]；p<.05）。末次随访时改良的 Engel 分级 I、II、III 和 IV 结果分别为 19.8%（n=17/86）、19.8%（n=17/86）、40.2%（n=35/86）和 19.8%（n=17/86）。70 例术前有发作性跌倒的患者中，75%（n=52/69）术后发作得到缓解。
意义：仅行前切 CC 和全切 CC 的患者之间的癫痫发作结果无显著差异。LITT 是 CC 的一种较微创的开颅术替代方法，与开颅术相比，其癫痫发作结果相似，出血量较少，住院时间较短，并发症发生率较低，但手术时间较长。
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