1Advent Health Orlando, Florida.
4Department of Neurosurgery, College of Medicine, University of Central Florida, Orlando, Florida.
J Neurosurg Pediatr. 2023 Sep 1;32(5):553-561. doi: 10.3171/2023.7.PEDS23119. Print 2023 Nov 1.
In this study, the authors describe their 10-year single-institution experience with single-step complete corpus callosotomy (CCC) for seizure management in pediatric and adult patients with catastrophic, medically refractory, nonlocalizing epilepsy at Advent Health Orlando.
The authors conducted a retrospective observational study of patients aged 6 months to 49 years who underwent clinically indicated CCC for drug-resistant nonlocalizing epilepsy at Advent Health Orlando between July 2011 and July 2021. Follow-up ranged from 12 months to 10 years.
Of the 101 patients (57% of whom were male) who met eligibility criteria, 81 were pediatric patients and 20 were ≥ 18 years. All patients had seizures that appeared poorly lateralized on both electroencephalograms and clinical semiological studies. Of 54 patients with drop seizures before CCC, 29 (54%) achieved stable freedom from drop seizures after CCC. Of the 101 patients, 14 (13.9%) experienced stable resolution of all types of clinical seizures (International League Against Epilepsy classes 1 and 2). The most common postoperative neurological complication was a transient disconnection syndrome, observed in 50% of patients; of those patients, 73% experienced syndrome resolution within 2 months after surgery, and all resolved by the 2-year follow-up. Formal neuropsychological test results were stable in 13 patients assessed after CCC.
CCC is an effective and well-tolerated palliative surgical technique. In this study, drop attacks were reduced after CCC but could recur for the first time as late as 44 months after surgery. Other seizure types were also reduced postoperatively but could recur for the first time as late as 28 months after surgery. Nearly 14% of patients achieved stable and complete freedom from seizures after CCC. Re-evaluation after CCC can reveal lateralized seizure onset in some patients.
本研究作者描述了其在 Advent Health Orlando 机构 10 年的单步全胼胝体切开术（CCC）治疗经验，该术式用于治疗患有灾难性、药物难治性、非局灶性癫痫的儿科和成年患者。
作者对 2011 年 7 月至 2021 年 7 月期间因药物难治性非局灶性癫痫在 Advent Health Orlando 接受临床提示性 CCC 的年龄在 6 个月至 49 岁的患者进行了回顾性观察性研究。随访时间为 12 个月至 10 年。
符合入选标准的 101 例患者（其中 57%为男性）中，81 例为儿科患者，20 例为≥18 岁患者。所有患者的脑电图和临床半定量研究均显示癫痫发作无明显局灶性。在 54 例有跌倒发作的患者中，29 例（54%）在 CCC 后实现了稳定的无跌倒发作。在 101 例患者中，14 例（13.9%）实现了所有类型临床发作的稳定缓解（国际抗癫痫联盟 1 级和 2 级）。最常见的术后神经并发症是短暂性离断综合征，50%的患者出现该并发症；其中 73%的患者在术后 2 个月内恢复，所有患者在 2 年随访时均恢复。在接受 CCC 后进行评估的 13 例患者中，正式神经心理学测试结果稳定。
CCC 是一种有效且耐受良好的姑息性手术技术。在本研究中，CCC 后跌倒发作减少，但术后首次复发可迟至 44 个月；其他发作类型术后也减少，但首次复发可迟至术后 28 个月。近 14%的患者在接受 CCC 后实现了稳定和完全无癫痫发作。CCC 后重新评估可揭示一些患者的起始侧化发作。
