Image-Guided, Frameless Stereotactic Sectioning of the Corpus callosum in Children with Intractable Epilepsy

Hodaie, Mojgan; Musharbash, Awni; Otsubo, Hiroshi; Snead, O. Carter; Chitoku, Shiro; Ochi, Ayako; Holowka, Stephanie; Hoffman, Harold J.; Rutka, James T.

doi:10.1159/000056040

Cited by 25 publications

(12 citation statements)

References 16 publications

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“…The initial literature search returned a total of 398 peer‐reviewed articles, and a total of 12 met inclusion criteria . The PRISMA flow diagram is shown in Figure .…”

Section: Resultsmentioning

confidence: 99%

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Corpus callosotomy outcomes in pediatric patients: A systematic review

2016

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SUMMARYObjective: Corpus callosotomy is a palliative neurosurgical treatment for patients with either generalized or multifocal refractory epilepsy and injurious drop attacks. This report aims to systematically review the pediatric literature. Methods: Medline, Embase, Web of Knowledge, and Scopus were searched systematically for published articles on treatment outcomes of corpus callosotomy for refractory epilepsy. Studies were included if the patient population was younger than 18 at the time of surgery and median follow-up was >1 year. Studies were excluded if resective surgery was also performed. Results: A total of 12 articles met inclusion criteria. All articles were retrospective case series, with the exception of one being a prospectively designed retrospective case series. There was very little agreement among authors on the definition of a good seizure outcome. Articles that used the Engel classification found that 88.2% of total corpus callosotomy patients had a worthwhile reduction in seizures compared with 58.6% of patients who underwent anterior corpus callosotomy (p < 0.05). Drop attacks improved from corpus callosotomy more than other generalized seizure types. Reported complications were minor in all but one patient, and one death was reported. Transient disconnection syndrome was significantly more likely in total corpus callosotomy than in anterior corpus callosotomy (12.5% vs. 0%; p < 0.05). Improvements in quality of life, behavior, and intelligence/development quotient, as well as parental satisfaction, were generally correlated with seizure outcome. There was no postcallosotomy change in the number of antiepileptic drugs. Significance: Total corpus callosotomy was significantly more likely to result in a reduction in seizures. Anterior corpus callosotomy was unlikely to result in disconnection syndrome. Although all of the papers drew a similar conclusion, the quality of evidence was low. At best, the evidence raises the hypothesis that corpus callosotomy is a safe and effective treatment for refractory generalized epilepsy. It is clear that a casecontrol or randomized trial is warranted.

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“…The initial literature search returned a total of 398 peer‐reviewed articles, and a total of 12 met inclusion criteria . The PRISMA flow diagram is shown in Figure .…”

Section: Resultsmentioning

confidence: 99%

“…Three articles included only patients with a diagnosis of LGS; one article included only patients with a history of West syndrome; five included patients with various syndromes and etiologies, but LGS was the most common syndrome/etiology in all of the articles. Three articles did not describe the etiology or syndrome …”

Section: Resultsmentioning

confidence: 99%

Corpus callosotomy outcomes in pediatric patients: A systematic review

2016

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“…2). 9 The side of the approach and size of the craniotomy may be determined on the basis of favorability of the bridging veins with respect to the extent of the callosotomy. The extent of the callosotomy may be determined by intraoperative feedback from the neuronavigation device.…”

Section: Image Guidancementioning

confidence: 99%

Corpus callosotomy in children with intractable epilepsy using frameless stereotactic neuronavigation: 12-year experience at The Hospital for Sick Children in Toronto

Jea

Vachhrajani

Johnson

et al. 2008

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Object Although corpus callosotomy has been used effectively since the late 1930s to treat severe, medically intractable seizure disorders, particularly atonic or drop-attack seizures, controversy remains as to when, how, and how much surgery should be performed. Intraoperative determination of the extent of callosotomy, the need to stage the procedure, and the side of the interhemispheric approach represent technical issues that remain debatable. The authors report the 12-year experience of the senior author as well as surgical outcomes with corpus callosotomy using a frameless stereotactic neuronavigation system (ISG View Wand and BrainLab). Methods Thirteen consecutive children at The Hospital for Sick Children underwent single-stage corpus callosotomy for medically intractable seizures. The mean age was 10.3 years. Five children underwent partial callosotomy, and 8 underwent complete callosotomy. The side of operative approach to avoid large parasagittal bridging veins was determined by preoperative study of 3D MR imaging/MR venography reconstructed by the neuronavigation system. The extent of callosotomy was determined using intraoperative feedback from the neuronavigation system and postoperative MR imaging. Results The extent of callosotomy determined by intraoperative neuronavigation and postoperative MR imaging correlated closely in all cases. There were no operative deaths. There was no significant postoperative morbidity related to venous infarction. Four of 5 patients in the partial callosotomy cohort and 7 of 8 patients in the complete callosotomy cohort showed significant improvement in seizure control. Conclusions The use of frameless stereotactic neuronavigation is a safe, effective, and important surgical adjunct in the planning and execution of successful corpus callosotomy in children with intractable epilepsy.

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“…1), intraoperatively to select the optimal approach angle during transtemporal approaches to temporal lobectomies, and diagnostically when placing recording depth electrodes in precise anatomical locations such as the amygdalae. 27,56,105 Neuronavigation can also reduce the invasiveness of procedures by eliminating the requirement to expose visible landmarks. For instance, the placement of subdural strip electrodes through a single enlarged temporooccipital bur hole using fluoroscopic guidance can be employed to localize the seizure focus in patients with TLE without the need for a conventional craniotomy.…”

Section: Anatomical Guidancementioning

confidence: 99%

Utility of neuronavigation and neuromonitoring in epilepsy surgery

Stone¹,

Rutka²

2008

FOC

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The management of medically refractory epilepsy poses both a valuable therapeutic opportunity and a formidable technical challenge to epilepsy surgeons. Recent decades have produced significant advancements in the capabilities and availability of adjunctive tools in epilepsy surgery. In particular, image-based neuronavigation and electrophysiological neuromonitoring represent versatile and informative modalities that can assist a surgeon in performing safe and effective resections. In the present article the authors discuss these 2 subjects with reference to how they can be applied and what evidence supports their use. As technologies evolve with demonstrated and potential utility, it is important for all clinicians who deal with epilepsy to understand where neuronavigation and neuromonitoring stand in the present and what avenues for improvement exist for the future.

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Image-Guided, Frameless Stereotactic Sectioning of the Corpus callosum in Children with Intractable Epilepsy

Cited by 25 publications

References 16 publications

Corpus callosotomy outcomes in pediatric patients: A systematic review

Corpus callosotomy outcomes in pediatric patients: A systematic review

Corpus callosotomy in children with intractable epilepsy using frameless stereotactic neuronavigation: 12-year experience at The Hospital for Sick Children in Toronto

Utility of neuronavigation and neuromonitoring in epilepsy surgery

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