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Jennifer Hong, Atman Desai, Vijay M. Thadani, and David W. Roberts

OBJECTIVE

Vagal nerve stimulation (VNS) and corpus callosotomy (CC) have both been shown to be of benefit in the treatment of medically refractory epilepsy. Recent case series have reviewed the efficacy of VNS in patients who have undergone CC, with encouraging results. There are few data, however, on the use of CC following VNS therapy.

METHODS

The records of all patients at the authors' center who underwent CC following VNS between 1998 and 2015 were reviewed. Patient baseline characteristics, operative details, and postoperative outcomes were analyzed.

RESULTS

Ten patients met inclusion criteria. The median follow-up was 72 months, with a minimum follow-up of 12 months (range 12–109 months). The mean time between VNS and CC was 53.7 months. The most common reason for CC was progression of seizures after VNS. Seven patients had anterior CC, and 3 patients returned to the operating room for a completion of the procedure. All patients had a decrease in the rate of falls and drop seizures; 7 patients experienced elimination of drop seizures. Nine patients had an Engel Class III outcome, and 1 patient had a Class IV outcome. There were 3 immediate postoperative complications and 1 delayed complication. One patient developed pneumonia, 1 developed transient mutism, and 1 had persistent weakness in the nondominant foot. One patient presented with a wound infection.

CONCLUSIONS

The authors demonstrate that CC can help reduce seizures in patients with medically refractory epilepsy following VNS, particularly with respect to drop attacks.

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Atman Desai, Barbara C. Jobst, Vijay M. Thadani, Krzysztof A. Bujarski, Karen Gilbert, Terrance M. Darcey, and David W. Roberts

into the insula. At our institution, implanted intracranial recording arrays for the investigation of medically intractable epilepsy are routinely employed. In patients with suspected insular involvement, insular depth electrodes are placed as part of the array. This study of our experience with insular depth electrodes was undertaken to evaluate their safety and efficacy in the diagnosis and treatment of patients with medically intractable epilepsy. Methods Selection Criteria Between 2001 and 2009, 20 patients with medically refractory epilepsy, in whom

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Kimon Bekelis, Atman Desai, Alex Kotlyar, Vijay Thadani, Barbara C. Jobst, Krzysztof Bujarski, Terrance M. Darcey, and David W. Roberts

focus in patients with medically refractory epilepsy. In a review of the literature, these authors also demonstrated the value of depth electrodes in changing the surgical strategy. 27 Subsequent work by the same group has shown that subdural electrodes were 20% less sensitive than depth electrodes in detecting seizures beginning in the hippocampus. 28 Despite the significant work of these and other authors 30 in establishing the value of depth electrodes and demonstrating the utility of OHDEs, their results largely refer to the pre-MRI era, which was characterized

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Oral Presentations

2010 AANS Annual Meeting Philadelphia, Pennsylvania May 1–5, 2010

factors associated with long-term seizure control after surgical resection. Methods: We conducted a retrospective review of 104 patients with cortical malformations who underwent surgery for medically refractory epilepsy. Demographic, seizure history, imaging, histopathologic, and surgical variables were collected and analyzed for potential association with freedom of seizure. Preoperative magnetic resonance images (MRIs) were evaluated in a blind fashion and classified according to the new a radiographic classification system for malformations of cortical