Effectiveness of total corpus callosotomy for diffuse bilateral polymicrogyria: Report of three pediatric cases

Corpus Callosotomy for Atonic Drop Seizures in Bilateral Malformations of Cortical Development: A Systematic Review of Literature

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.

A Comprehensive Review of Recent Trends in Surgical Approaches for Epilepsy Management

Epilepsy is a neurological disorder that affects millions of people worldwide, with a significant proportion of patients experiencing drug-resistant epilepsy, where seizures remain uncontrolled despite medical treatment. This review evaluates the latest surgical techniques for managing epilepsy, focusing on their effectiveness, safety, and the ongoing challenges that hinder their broader adoption. We explored various databases including PubMed, Google Scholar, and Cochrane Library to look for relevant literature using the following keywords: Epilepsy, Resective Surgery, Corpus Collectumy, and Antiepileptic Drugs. A total of 54 relevant articles were found and thoroughly explored. Recent advancements in surgical interventions include resective procedures such as anterior temporal lobectomy, corpus callosotomy, and hemispherectomy, which have been particularly effective in reducing seizures for specific types of epilepsy. Minimally invasive techniques, including laser interstitial thermal therapy and focused ultrasound, are increasingly being used, offering promising outcomes for certain patient groups. Additionally, neuromodulation methods such as deep brain stimulation, vagus nerve stimulation, and responsive neurostimulation provide alternative treatment options, especially for patients who are not suitable candidates for resective surgery. Despite these advancements, the full potential of epilepsy surgery is often underutilized due to various challenges. Inconsistent referral practices, a lack of standardized surgical protocols, and significant socioeconomic barriers continue to limit access to these procedures. Addressing these issues through improved referral processes, better education for healthcare providers and patients, and ensuring equitable access to advanced surgical treatments is crucial for optimizing patient outcomes. Future research should focus on overcoming these barriers and assessing long-term outcomes to further enhance the care of patients with epilepsy.

Corpus Callosotomy for Controlling Epileptic Spasms: A Proposal for Surgical Selection

In 1940, van Wagenen and Herren first proposed the corpus callosotomy (CC) as a surgical procedure for epilepsy. CC has been mainly used to treat drop attacks, which are classified as generalized tonic or atonic seizures. Epileptic spasms (ESs) are a type of epileptic seizure characterized as brief muscle contractions with ictal polyphasic slow waves on an electroencephalogram and a main feature of West syndrome. Resection surgeries, including frontal/posterior disconnections and hemispherotomy, have been established for the treatment of medically intractable ES in patients with unilaterally localized epileptogenic regions. However, CC has also been adopted for ES treatment, with studies involving CC to treat ES having increased since 2010. In those studies, patients without lesions observed on magnetic resonance imaging or equally bilateral lesions predominated, in contrast to studies on resection surgeries. Here, we present a review of relevant literature concerning CC and relevant adaptations. We discuss history and adaptations of CC, and patient selection for epilepsy surgeries due to medically intractable ES, and compared resection surgeries with CC. We propose a surgical selection flow involving resection surgery or CC as first-line treatment for patients with ES who have been assessed as suitable candidates for surgery.

Corpus Callosotomy for Refractory Epilepsy in Aicardi Syndrome: Case Report and Focused Review of the Literature

BACKGROUND

Aicardi syndrome is a severe neurodevelopmental disorder that occurs primarily in females and is characterized by seizures, agenesis of the corpus callosum, and chorioretinal lacunae, which occur together in the majority of affected individuals. Seizures begin in infancy and tend to progress in intensity and are often refractory to standard multimodal medication treatments.

CASE DESCRIPTION

We present here a unique case of a 12-year-old girl with partial agenesis of the corpus callosum who underwent a corpus callosotomy for treatment of medically refractory epilepsy. In so doing, we also review the literature with regard to the neurosurgical management of these unique patients.

CONCLUSIONS

For the subset of children who present with partial, rather than complete, agenesis of the corpus callosum, corpus callosotomy should be considered as a treatment option to reduce seizure burden.

Corpus callosotomy for drug-resistant spasms associated with tuberous sclerosis complex

BACKGROUND

Corpus callosotomy (CC) has recently been adopted for the treatment of drug-resistant epileptic spasms and tonic spasms. In the present study, we investigated CC outcomes among patients with drug-resistant epileptic spasms or tonic spasms associated with tuberous sclerosis complex (TSC).

METHODS

We retrospectively collected data from seven patients (3 women, 4 men) with diagnosed TSC and who were treated using CC at Seirei Hamamatsu General Hospital in Japan. All patients had experienced drug-resistant epileptic spasms (<3 s of muscular contraction) or tonic spasms (>3 s) prior to CC, which were confirmed via video-electroencephalogram monitoring.

RESULTS

All patients exhibited multiple bilateral cortical tubers on brain magnetic resonance imaging. The main seizure types were epileptic spasms in four, tonic spasms in one, and both seizure types in two patients. Patients underwent total CC between the ages of 25 months and 21.5 years. Additional resection or disconnection was performed in two patients. The follow-up period after CC ranged between 9 months and 3.5 years. Three patients achieved remission from spasms following CC alone. Two other patients became free from spasms several months after CC but required an additional focus disconnection or medical treatment. The remaining two patients continued to show spasms or asymmetrical tonic seizures.

CONCLUSION

Total CC resulted in freedom from drug-resistant epileptic or tonic spasms in several patients with TSC. Stepwise progression from CC to additional resection or disconnection surgery may aid in the treatment of spasms secondary to TSC.