Abstract：
In this study, the authors describe their 10-year single-institution experience with single-step complete corpus callosotomy (CCC) for seizure management in pediatric and adult patients with catastrophic, medically refractory, nonlocalizing epilepsy at Advent Health Orlando.
The authors conducted a retrospective observational study of patients aged 6 months to 49 years who underwent clinically indicated CCC for drug-resistant nonlocalizing epilepsy at Advent Health Orlando between July 2011 and July 2021. Follow-up ranged from 12 months to 10 years.
Of the 101 patients (57% of whom were male) who met eligibility criteria, 81 were pediatric patients and 20 were ≥ 18 years. All patients had seizures that appeared poorly lateralized on both electroencephalograms and clinical semiological studies. Of 54 patients with drop seizures before CCC, 29 (54%) achieved stable freedom from drop seizures after CCC. Of the 101 patients, 14 (13.9%) experienced stable resolution of all types of clinical seizures (International League Against Epilepsy classes 1 and 2). The most common postoperative neurological complication was a transient disconnection syndrome, observed in 50% of patients; of those patients, 73% experienced syndrome resolution within 2 months after surgery, and all resolved by the 2-year follow-up. Formal neuropsychological test results were stable in 13 patients assessed after CCC.
CCC is an effective and well-tolerated palliative surgical technique. In this study, drop attacks were reduced after CCC but could recur for the first time as late as 44 months after surgery. Other seizure types were also reduced postoperatively but could recur for the first time as late as 28 months after surgery. Nearly 14% of patients achieved stable and complete freedom from seizures after CCC. Re-evaluation after CCC can reveal lateralized seizure onset in some patients.
The authors conducted a retrospective observational study of patients aged 6 months to 49 years who underwent clinically indicated CCC for drug-resistant nonlocalizing epilepsy at Advent Health Orlando between July 2011 and July 2021. Follow-up ranged from 12 months to 10 years.
Of the 101 patients (57% of whom were male) who met eligibility criteria, 81 were pediatric patients and 20 were ≥ 18 years. All patients had seizures that appeared poorly lateralized on both electroencephalograms and clinical semiological studies. Of 54 patients with drop seizures before CCC, 29 (54%) achieved stable freedom from drop seizures after CCC. Of the 101 patients, 14 (13.9%) experienced stable resolution of all types of clinical seizures (International League Against Epilepsy classes 1 and 2). The most common postoperative neurological complication was a transient disconnection syndrome, observed in 50% of patients; of those patients, 73% experienced syndrome resolution within 2 months after surgery, and all resolved by the 2-year follow-up. Formal neuropsychological test results were stable in 13 patients assessed after CCC.
CCC is an effective and well-tolerated palliative surgical technique. In this study, drop attacks were reduced after CCC but could recur for the first time as late as 44 months after surgery. Other seizure types were also reduced postoperatively but could recur for the first time as late as 28 months after surgery. Nearly 14% of patients achieved stable and complete freedom from seizures after CCC. Re-evaluation after CCC can reveal lateralized seizure onset in some patients.
摘要：
目的：在本研究中，作者描述了他们10年的单一机构的经验，在儿童和成人患者的癫痫发作管理与灾难性的单步完全骨体切开术（CCC），药物难治性，奥兰多AdventHealth的非局限性癫痫。
方法：作者在2011年7月至2021年7月期间，在AdventHealthOrlando，对6个月至49岁的患者进行了一项回顾性观察研究，这些患者在临床上因耐药非定位性癫痫而接受了CCC治疗。随访时间为12个月至10年。
结果：在符合资格标准的101名患者（其中57%为男性）中，81例儿科患者，20例≥18岁。所有患者的癫痫发作在脑电图和临床符号学研究中均表现为偏侧差。在CCC前发作的54例患者中，29人(54%)在CCC后实现了稳定的免于跌落癫痫发作。101名患者中,14（13.9％）经历了所有类型的临床癫痫发作的稳定解决（国际抗癫痫联盟1级和2级）。术后最常见的神经系统并发症是短暂的断流综合征，在50%的患者中观察到；在这些患者中，73%的患者在术后2个月内经历了综合征消退，并通过2年的随访解决。CCC后评估的13例患者的正式神经心理学测试结果稳定。
结论：CCC是一种有效且耐受性良好的姑息性手术技术。在这项研究中,下降发作减少后CCC，但可以复发，直到44个月后的第一次手术。其他癫痫发作类型也在术后减少，但可能在术后28个月后首次复发。近14％的患者在CCC后实现了稳定和完全的癫痫发作。CCC后的重新评估可以揭示某些患者的癫痫发作偏侧化。
方法：作者在2011年7月至2021年7月期间，在AdventHealthOrlando，对6个月至49岁的患者进行了一项回顾性观察研究，这些患者在临床上因耐药非定位性癫痫而接受了CCC治疗。随访时间为12个月至10年。
结果：在符合资格标准的101名患者（其中57%为男性）中，81例儿科患者，20例≥18岁。所有患者的癫痫发作在脑电图和临床符号学研究中均表现为偏侧差。在CCC前发作的54例患者中，29人(54%)在CCC后实现了稳定的免于跌落癫痫发作。101名患者中,14（13.9％）经历了所有类型的临床癫痫发作的稳定解决（国际抗癫痫联盟1级和2级）。术后最常见的神经系统并发症是短暂的断流综合征，在50%的患者中观察到；在这些患者中，73%的患者在术后2个月内经历了综合征消退，并通过2年的随访解决。CCC后评估的13例患者的正式神经心理学测试结果稳定。
结论：CCC是一种有效且耐受性良好的姑息性手术技术。在这项研究中,下降发作减少后CCC，但可以复发，直到44个月后的第一次手术。其他癫痫发作类型也在术后减少，但可能在术后28个月后首次复发。近14％的患者在CCC后实现了稳定和完全的癫痫发作。CCC后的重新评估可以揭示某些患者的癫痫发作偏侧化。
