Corpus callosotomy in multistage epilepsy surgery in the pediatric population

Clinical article

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Object

The object of this study was to evaluate surgical outcome in a select group of patients with medically refractory epilepsy who had undergone corpus callosotomy combined with bilateral subdural electroencephalography (EEG) electrode placement as the initial step in multistage epilepsy surgery.

Methods

A retrospective chart review of 18 children (ages 3.5–18 years) with medically refractory symptomatic generalized or localization-related epilepsy was undertaken. A corpus callosotomy with subdural bihemispheric EEG electrode placement was performed as the initial step in multistage epilepsy surgery. All of the patients had tonic and atonic seizures; 6 patients also experienced complex partial seizures. All of the patients had frequent generalized epileptiform discharges as well as multifocal independent epileptiform discharges on surface EEG monitoring. Most of the patients (94%) had either normal (44%) MR imaging studies of the brain or bihemispheric abnormalities (50%). One patient had a suspected unilateral lesion (prominent sylvian fissure).

Results

Of the 18 patients who underwent corpus callosotomy and placement of subdural strips and grids, 12 progressed to further resection based on localizing data obtained during invasive EEG monitoring. The mean patient age was 10.9 years. The duration of invasive monitoring ranged from 3 to 14 days, and the follow-up ranged from 6 to 70 months (mean 35 months). Six (50%) of the 12 patients who had undergone resection had an excellent outcome (Engel Class I or II). There were no permanent neurological deficits or deaths.

Conclusions

The addition of invasive monitoring for patients undergoing corpus callosotomy for medically refractory epilepsy may lead to the localization of surgically amenable seizure foci, targeted resections, and improved seizure outcomes in a select group of patients typically believed to be candidates for palliative surgery alone.

Abbreviations used in this paper: EEG = electroencephalography; FSIQ = full-scale intelligence quotient; iEEG = intracranial EEG; SUDEP = sudden unexplained death in epilepsy; VABS = Vineland Adaptive Behavior Scales.

Article Information

Address correspondence to: Sean M. Lew, M.D., Department of Neurosurgery, Children's Hospital of Wisconsin, 999 North 92nd Street, Suite 310, Milwaukee, Wisconsin 53226. email: slew@mcw.edu.

© AANS, except where prohibited by US copyright law.

Headings

Figures

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    Case 13. Postoperative skull radiograph demonstrating C-shaped interhemispheric grid and bilateral subdural electrode placement following callosotomy.

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    Bar graph demonstrating seizure outcome in 18 patients undergoing callosotomy with concurrent bilateral intracranial monitoring. Twelve patients underwent further resection (gray bars), and 6 patients had callosotomy without further resection (black bars). Engel Class I, seizure free; II, rare disabling seizures; III, worthwhile seizure reduction; and IV, no worthwhile improvement in seizures.

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    Case 13. Preoperative MR imaging. Left: Sagittal T1-weighted MR image showing a markedly diminished posterior corpus callosum. Right: Coronal FLAIR sequence demonstrating diminished white matter volume with abnormal hyperintensity bilaterally.

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    Case 13. Coronal ictal FDG-PET images demonstrating increased uptake in the right hemisphere relative to the left, most prominently in the frontal and parietal lobes.

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    Case 13. Preoperative surface awake EEG traces showing independent, bilateral, generalized, multifocal discharges maximally seen in the right hemisphere.

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    Case 13. Preoperative surface asleep EEG traces showing generalized continuous spike and slow-wave discharges consistent with electrographic status epilepticus of slow-wave sleep.

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    Case 13. Tracings from iEEG following corpus callosotomy (2-sided interhemispheric grid and bilateral electrode strips). Right-sided electrodes are represented on the top half of the tracings, left-sided electrodes on the bottom half. Maximal epileptiform activity was seen in the right hemisphere, predominantly in the posterior quadrant.

References

  • 1

    Asadi-Pooya AASharan ANei MSperling MR: Corpus callosotomy. Epilepsy Behav 13:2712782008

  • 2

    Beran RGWeber SSungaran RVenn NHung A: Review of the legal obligations of the doctor to discuss Sudden Unexplained Death in Epilepsy (SUDEP)—a cohort controlled comparative cross-matched study in an outpatient epilepsy clinic. Seizure 13:5235282004

  • 3

    Burneo JGSteven DAMcLachlan RSParrent AG: Morbidity associated with the use of intracranial electrodes for epilepsy surgery. Can J Neurol Sci 33:2232272006

  • 4

    Clarke DFWheless JWChacon MMBreier JKoenig MKMcManis M: Corpus callosotomy: a palliative therapeutic technique may help identify resectable epileptogenic foci. Seizure 16:5455532007

  • 5

    Cobb WAGuiloff RJCast J: Breach rhythm: the EEG related to skull defects. Electroencephalogr Clin Neurophysiol 47:2512711979

  • 6

    Commission on Classification and Terminology of the International League Against Epilepsy: Proposal for revised classification of epilepsies and epileptic syndromes. Epilepsia 30:3893991989

  • 7

    Dasheiff RM: Sudden unexpected death in epilepsy: a series from an epilepsy surgery program and speculation on the relationship to sudden cardiac death. J Clin Neurophysiol 8:2162221991

  • 8

    Elliott CD: Differential Ability Scales: Introductory and Technical Handbook San AntonioPsychological Corp, Harcourt Brace Jovanovich1990

  • 9

    Fountas KNSmith JR: Subdural electrode-associated complications: a 20-year experience. Stereotact Funct Neurosurg 85:2642722007

  • 10

    Gastraut HRoger JSoulayrol RTassinari CARégis HDravet C: Childhood epileptic encephalopathy with diffuse slow spike-waves (otherwise known as “petit mal variant”) or Lennox syndrome. Epilepsia 7:1391791966

  • 11

    Hamer HMMorris HHMascha EJKarafa MTBingaman WEBej MD: Complications of invasive video-EEG monitoring with subdural grid electrodes. Neurology 58:97 1032002

  • 12

    Hitiris NSuratman SKelly KStephen LJSills GJBrodie MJ: Sudden unexpected death in epilepsy: a search for risk factors. Epilepsy Behav 10:1381412007

  • 13

    Jick SSCole TBMesher RATennis PJick H: Sudden unexpected death in young persons with primary epilepsy. Pharmacoepidemiol Drug Saf 1:59641992

  • 14

    Johnston JM JrMangano FTOjemann JGPark TSTrevathan ESmyth MD: Complications of invasive subdural electrode monitoring at St. Louis Children's Hospital, 1994–2005. J Neurosurg 105:5 Suppl3433472006

  • 15

    Kloster REngelskjøn T: Sudden unexpected death in epilepsy (SUDEP): a clinical perspective and a search for risk factors. J Neurol Neurosurg Psychiatry 67:4394441999

  • 16

    Langan YNashef LSander JW: Case-control study of SUDEP. Neurology 64:113111332005

  • 17

    Lee JWTanaka NShiraishi HMilligan TADworetzky BAKhoshbin S: Evaluation of postoperative sharp waveforms through EEG and magnetoencephalography. J Clin Neurophysiol 27:7112010

  • 18

    Lee WSLee JKLee SAKang JKKo TS: Complications and results of subdural grid electrode implantation in epilepsy surgery. Surg Neurol 54:3463512000

  • 19

    McKee JRBodfish JW: Sudden unexpected death in epilepsy in adults with mental retardation. Am J Ment Retard 105:2292352000

  • 20

    Mullen EM: Mullen Scales of Early Learning Manual Circle Pines, MNAmerican Guidance Service1995

  • 21

    Nashef LFish DRGarner SSander JWShorvon SD: Sudden death in epilepsy: a study of incidence in a young cohort with epilepsy and learning difficulty. Epilepsia 36:118711941995

  • 22

    Nei MO'Connor MLiporace JSperling MR: Refractory generalized seizures: response to corpus callosotomy and vagal nerve stimulation. Epilepsia 47:1151222006

  • 23

    Nilsson LAhlbom AFarahmand BYTomson T: Mortality in a population-based cohort of epilepsy surgery patients. Epilepsia 44:5755812003

  • 24

    Nilsson LFarahmand BYPersson PGThiblin ITomson T: Risk factors for sudden unexpected death in epilepsy: a case-control study. Lancet 353:8888931999

  • 25

    Palmini ANajm IAvanzini GBabb TGuerrini RFoldvary-Schaefer N: Terminology and classification of the cortical dysplasias. Neurology 62:6 Suppl 3S2S82004

  • 26

    Purves SJSelection of patients for corpus callosum section. Spencer SSSpencer DD: Surgery for Epilepsy: Contemporary Issues in Neurological Surgery CambridgeBlackwell Scientific Publications1991. 2:6986

  • 27

    Rahimi SYPark YDWitcher MRLee KHMarrufo MLee MR: Corpus callosotomy for treatment of pediatric epilepsy in the modern era. Pediatr Neurosurg 43:2022082007

  • 28

    Roid GH: Stanford-Binet Intelligence Scales ed 5Itasca, ILRiverside Publishing2003

  • 29

    Sassower KCRollinson DCDuchowny M: Outcome of corpus callosotomy and other pediatric epilepsy surgery: parental perceptions. Epileptic Disord 3:1972022001

  • 30

    Schnabel RBeblo MMay TW: Is geomagnetic activity a risk factor for sudden unexplained death in epilepsies?. Neurology 54:9039082000

  • 31

    Shim KWLee YMKim HDLee JSChoi JUKim DS: Changing the paradigm of 1-stage total callosotomy for the treatment of pediatric generalized epilepsy. J Neurosurg Pediatr 2:29362008

  • 32

    Sparrow SSBalla DACicchetti DVDoll EA: Vineland Adaptive Behavior Scales: Interview Edition Survey Form Manual Circle Pines, MNAmerican Guidance Service1984

  • 33

    Tanriverdi TOlivier APoulin NAndermann FDubeau F: Long-term seizure outcome after corpus callosotomy: a retrospective analysis of 95 patients. Clinical article. J Neurosurg 110:3323422009

  • 34

    Thorndike RLHagen EPSattler JM: The Stanford-Binet Intelligence Scale: Guide for Administering and Scoring ed 4Chicago, ILRiverside Publishing1986

  • 35

    Tomson TNashef LRyvlin P: Sudden unexpected death in epilepsy: current knowledge and future directions. Lancet Neurol 7:102110312008

  • 36

    Turanli GYalnizoğlu DGenç-Açikgöz DAkalan NTopçu M: Outcome and long term follow-up after corpus callosotomy in childhood onset intractable epilepsy. Childs Nerv Syst 22:132213272006

  • 37

    Van Wagenen WPHerren RY: Surgical division of commissural pathways in the corpus callosum. Relation to spread of an epileptic attack. Arch Neurol Psychiatry 44:7407591940

  • 38

    Vlooswijk MCMajoie HJDe Krom MCTan IYAldenkamp AP: SUDEP in the Netherlands: a retrospective study in a tertiary referral center. Seizure 16:1531592007

  • 39

    Wechsler D: WISC-III: Wechsler Intelligence Scale for Children ed 3San AntonioPsychological Corporation1991

  • 40

    Wong CHBirkett JByth KDexter MSomerville EGill D: Risk factors for complications during intracranial electrode recording in presurgical evaluation of drug resistant partial epilepsy. Acta Neurochir (Wien) 151:37502009

  • 41

    Wong TTKwan SYChang KPHsiu-Mei WYang TFChen YS: Corpus callosotomy in children. Childs Nerv Syst 22:99910112006

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