The Impact of Intraoperative MRI Confirming Completeness of Corpus Callosotomy and Tissue Biopsy on the Outcome of Pediatric Patients with Drug Refractory Epilepsy
Abstract number :
2.445
Submission category :
9. Surgery / 9B. Pediatrics
Year :
2024
Submission ID :
790
Source :
www.aesnet.org
Presentation date :
12/8/2024 12:00:00 AM
Published date :
Authors :
Presenting Author: Laurence Veilleux, NP, MSc – McGill University Health Centre
Myriam Srour, MDCM, PhD – McGill University Health Centre
Michele Larose, MD – Policlinique SOMANA
Bradley Osterman, MD – McGill University Health Centre
David Dufresne, MD – Sherbrooke University
Roy Dudley, MD, PhD – McGill University
Rationale: Corpus callosotomy (CC) is considered a palliative surgery for drug refractory epilepsy, but post-CC seizure outcomes vary greatly, from little benefit to rare seizure freedom. Complete CC has been inconsistently associated with improved outcomes, but studies using strict criteria to demonstrate complete disconnection are lacking. Furthermore, the lack of a tissue diagnosis from CC cases has contributed to a poor understanding of what pathologies could benefit most from this procedure. We have taken an approach of using intraoperative MRI (iMRI) to confirm complete disconnections and performing brain biopsies during CC in hopes of overcoming these challenges.
Methods: We performed a predominantly prospective data collection on the first 9 consecutive pediatric patients operated using this approach at the Montreal Children’s Hospital from 2022 to 2024. We reviewed completeness of CC, seizure outcome, behavioral outcome, development outcome, biopsy results, anti-seizure medication (ASM) changes, complications, and signs suggesting that CC unmasked a unilateral epileptogenic zone (EZ).
Results: Seven patients had complete CC. With a mean follow-up 7.8 months, 3 patients obtained seizure freedom, 3 had 75-99% reduction, 2 had 50-75% reduction, 0 had < 50% reduction in seizures, and 1 patient no change. Five patients experienced transient behavioral issues. All patients but one had significant gains in development. Four patients had positive biopsy findings. Five patients had reduction in ASM, 3 patients had unchanged ASM, and one patient had an increase in ASM. Two patients had transient complications. In 2 patients, unilateral EZ were unmasked.
Conclusions: Our results suggest the approach of verifying the completeness of CC with iMRI may be beneficial in terms of seizure and developmental outcomes without long term behavioral problems or complications. The addition of biopsies and the potential of unmasking focal EZ can improve our understanding of the patient’s ideology of epilepsy, thus impacting future treatment decisions.
Funding: No funding.
Surgery