June 14, 2023

Surgical Outcomes of Open and Laser Interstitial Thermal Therapy (LITT) Approaches for Corpus Callosotomy in Pediatric Epilepsy

Abstract found on Wiley Online Library

Objective: Corpus callosotomy (CC) is a palliative surgical intervention for patients with medically refractory epilepsy that has evolved in recent years to include a less invasive alternative with the use of laser interstitial thermal therapy (LITT). LITT works by heating a stereotactically placed laser fiber to ablative temperatures under real-time MRI thermometry. This study aims to 1) describe the surgical outcomes of CC in a large cohort of children with medically refractory epilepsy, 2) compare anterior and complete CC, and 3) review LITT as a surgical alternative to open craniotomy for corpus callosotomy.

Methods: This retrospective cohortcohort study included 103 patients <21 years old with at least 1 year follow-up at a single institution between 2003 and 2021. Surgical outcomes and the comparative effectiveness of anterior versus complete and open versus LITT surgical approaches were assessed.

Results: Complete callosotomy was the most common surgical disconnection (65%, n=67) followed by anterior two-thirds (35%, n=36), with a portion proceeding to posterior completion (28%, n=10). The overall surgical complication rate was 6% (n=6/103). Open craniotomy was the most common approach (87%, n=90), with LITT used increasingly in recent years (13%, n=13). Compared to open, LITT had shorter hospital stay (3  days [IQR 2-5] vs. 5 days [IQR 3-7]; p<0.05). Modified Engel I, II, III, and IV outcomes at last follow-up were 19.8% (n=17/86), 19.8% (n=17/86), 40.2% (n=35/86), and 19.8% (n=17/86). Of the 70 patients with preoperative drop seizures, 75% resolved postoperatively (n=52/69).

Significance: No significant differences in seizure outcome between patients who underwent only anterior corpus callosotomy and complete corpus callosotomy were observed. LITT is a less invasive surgical alternative to open craniotomy for corpus callosotomy, associated with similar seizure outcomes, lower blood loss, shorter hospital stays, and lower complication rates, but with longer operative times, when compared with the open craniotomy approach.

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