Kosco Ethan, Back Warren, Lucarelli Vito, Acharya Aditya, Waack Andrew, Schroeder Jason
Department of Neurological Surgery, The University of Toledo College of Medicine and Life Sciences, Toledo, USA.
Cureus. 2025 Mar 28;17(3):e81359. doi: 10.7759/cureus.81359. eCollection 2025 Mar.
Malformations of cortical development (MCD) frequently manifest with epilepsy, often refractory to medical treatment. Atonic seizures, prevalent in MCD, pose significant challenges. Surgical interventions like corpus callosotomy are considered when medical control fails. However, debate persists over optimal techniques, particularly in bilateral MCD (BMCD). A systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines analyzed studies on corpus callosotomy for atonic seizures in BMCD. Eligible studies encompassed patients undergoing anterior or total callosotomy post-failed medical therapy. Data extraction and quality assessment were performed independently by two reviewers. Nineteen primary articles involving 187 patients were included, analyzing outcomes of total callosotomy (TC) versus partial callosotomy (PC) in various BMCD types. TC demonstrated favorable seizure cessation rates, with notable improvements in tuberous sclerosis and cortical dysplasia cases. PC showed efficacy, especially in subcortical band heterotopia. Studies highlighted the need for long-term follow-up to assess sustained efficacy and neurocognitive impacts. This review underscores the potential of total callosotomy in severe refractory epilepsy associated with BMCD while acknowledging the utility of partial callosotomy in selected cases. Individualized approaches guided by pathology and seizure phenotype are crucial. Future research should focus on optimizing surgical techniques and exploring adjunctive therapies. Corpus callosotomy offers promise in managing atonic seizures in BMCD. Tailored surgical strategies, guided by comprehensive patient assessment, are essential. Continued research is imperative to refine techniques and enhance outcomes for this challenging patient population.
皮质发育畸形（MCD）常表现为癫痫，且药物治疗往往难以奏效。失张力性癫痫发作在MCD中很常见，带来了重大挑战。当药物治疗无法控制病情时，会考虑进行胼胝体切开术等手术干预。然而，对于最佳技术仍存在争议，尤其是在双侧MCD（BMCD）中。一项遵循系统评价与Meta分析优先报告项目（PRISMA）指南的系统评价分析了关于BMCD中失张力性癫痫发作的胼胝体切开术的研究。符合条件的研究包括药物治疗失败后接受前部或完全胼胝体切开术的患者。两名 reviewers 独立进行数据提取和质量评估。纳入了19篇涉及187例患者的主要文章，分析了不同BMCD类型中完全胼胝体切开术（TC）与部分胼胝体切开术（PC）的结果。TC显示出良好的癫痫停止率，在结节性硬化症和皮质发育异常病例中有显著改善。PC显示出疗效，尤其是在皮质下带状异位症中。研究强调需要长期随访以评估持续疗效和神经认知影响。本综述强调了完全胼胝体切开术在与BMCD相关的严重难治性癫痫中的潜力，同时承认部分胼胝体切开术在特定病例中的效用。以病理和癫痫表型为指导的个体化方法至关重要。未来的研究应专注于优化手术技术和探索辅助治疗。胼胝体切开术在管理BMCD中的失张力性癫痫发作方面具有前景。以全面的患者评估为指导的定制手术策略至关重要。持续研究对于改进技术和改善这一具有挑战性的患者群体的结局势在必行。
