Comparison of magnetic resonance‐guided laser interstitial thermal therapy corpus callosum ablation to open microsurgical corpus callosotomy: A single‐center retrospective cohort study
Abstract Objective Corpus callosotomy (CC) is an important treatment for atonic seizures in patients with generalized or multifocal drug‐resistant epilepsy (DRE). Traditionally, CC is performed via an open microsurgical approach, but more recently, MR‐guided stereotactic laser interstitial thermal t...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2024-02-01
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| Series: | Epilepsia Open |
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| Online Access: | https://doi.org/10.1002/epi4.12835 |
| _version_ | 1797324282256162816 |
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| author | H. Westley Phillips Jasmine L. Hect Emily Harford Evelyn Pan Taylor J. Abel |
| author_facet | H. Westley Phillips Jasmine L. Hect Emily Harford Evelyn Pan Taylor J. Abel |
| author_sort | H. Westley Phillips |
| collection | DOAJ |
| description | Abstract Objective Corpus callosotomy (CC) is an important treatment for atonic seizures in patients with generalized or multifocal drug‐resistant epilepsy (DRE). Traditionally, CC is performed via an open microsurgical approach, but more recently, MR‐guided stereotactic laser interstitial thermal therapy (LITT) corpus callosum ablation (CCA) has been developed to leverage the safety and minimally invasive nature of LITT. Given the recent adoption of CCA at select centers, how CCA compares to CC is unknown. We aim to compare the clinical seizure outcomes of CCA and CC after extended follow‐up. Methods We performed a retrospective cohort study to compare the effectiveness and safety of CC to CCA from 1994 to 2022. The primary outcome was a 50% reduction in target seizure. Secondary outcome measures were postoperative length of stay, adverse events, and other effectiveness metrics. Comparative statistics were executed using Stata. Normality for continuous variables was assessed, and parametric statistics were utilized as needed. Frequency was compared with chi‐squared or Fischer's exact tests, when applicable. Results Data from 47 operations performed on 36 patients were included in this study, of which 13 (36%) patients underwent 17 CCA. Patients who received CCA had similar rates of meaningful reduction (>50%) of atonic seizures as their CC counterparts (55% vs 70% P = 0.15). Patients undergoing CCA had significantly shorter hospitalizations than those receiving CC (2.5 vs 6.0 days P < 0.001). There was no significant difference in rates of postoperative complications between the groups, although the magnitude of the complication rates was lower in the CCA cohort (12% vs 28%). Significance This early experience suggests CCA has similar outcomes to traditional CC, albeit with a shorter hospital stay. However, future studies are necessary to investigate the noninferiority between these two approaches. Large multicenter studies are necessary to investigate differences in adverse events and whether these findings generalize across other centers. |
| first_indexed | 2024-03-08T05:53:51Z |
| format | Article |
| id | doaj.art-9ad9bbdb32e0414d9757a2470ea2987b |
| institution | Directory Open Access Journal |
| issn | 2470-9239 |
| language | English |
| last_indexed | 2024-03-08T05:53:51Z |
| publishDate | 2024-02-01 |
| publisher | Wiley |
| record_format | Article |
| series | Epilepsia Open |
| spelling | doaj.art-9ad9bbdb32e0414d9757a2470ea2987b2024-02-05T06:37:58ZengWileyEpilepsia Open2470-92392024-02-01919610510.1002/epi4.12835Comparison of magnetic resonance‐guided laser interstitial thermal therapy corpus callosum ablation to open microsurgical corpus callosotomy: A single‐center retrospective cohort studyH. Westley Phillips0Jasmine L. Hect1Emily Harford2Evelyn Pan3Taylor J. Abel4Department of Neurosurgery Stanford University School of Medicine Palo Alto California USADepartment of Neurological Surgery University of Pittsburgh Pittsburgh Pennsylvania USADepartment of Neurological Surgery University of Pittsburgh Pittsburgh Pennsylvania USADepartment of Neurological Surgery University of Pittsburgh Pittsburgh Pennsylvania USADepartment of Neurological Surgery University of Pittsburgh Pittsburgh Pennsylvania USAAbstract Objective Corpus callosotomy (CC) is an important treatment for atonic seizures in patients with generalized or multifocal drug‐resistant epilepsy (DRE). Traditionally, CC is performed via an open microsurgical approach, but more recently, MR‐guided stereotactic laser interstitial thermal therapy (LITT) corpus callosum ablation (CCA) has been developed to leverage the safety and minimally invasive nature of LITT. Given the recent adoption of CCA at select centers, how CCA compares to CC is unknown. We aim to compare the clinical seizure outcomes of CCA and CC after extended follow‐up. Methods We performed a retrospective cohort study to compare the effectiveness and safety of CC to CCA from 1994 to 2022. The primary outcome was a 50% reduction in target seizure. Secondary outcome measures were postoperative length of stay, adverse events, and other effectiveness metrics. Comparative statistics were executed using Stata. Normality for continuous variables was assessed, and parametric statistics were utilized as needed. Frequency was compared with chi‐squared or Fischer's exact tests, when applicable. Results Data from 47 operations performed on 36 patients were included in this study, of which 13 (36%) patients underwent 17 CCA. Patients who received CCA had similar rates of meaningful reduction (>50%) of atonic seizures as their CC counterparts (55% vs 70% P = 0.15). Patients undergoing CCA had significantly shorter hospitalizations than those receiving CC (2.5 vs 6.0 days P < 0.001). There was no significant difference in rates of postoperative complications between the groups, although the magnitude of the complication rates was lower in the CCA cohort (12% vs 28%). Significance This early experience suggests CCA has similar outcomes to traditional CC, albeit with a shorter hospital stay. However, future studies are necessary to investigate the noninferiority between these two approaches. Large multicenter studies are necessary to investigate differences in adverse events and whether these findings generalize across other centers.https://doi.org/10.1002/epi4.12835atonic seizureslaser ablationpediatric drug‐resistant epilepsyseizure outcomes |
| spellingShingle | H. Westley Phillips Jasmine L. Hect Emily Harford Evelyn Pan Taylor J. Abel Comparison of magnetic resonance‐guided laser interstitial thermal therapy corpus callosum ablation to open microsurgical corpus callosotomy: A single‐center retrospective cohort study Epilepsia Open atonic seizures laser ablation pediatric drug‐resistant epilepsy seizure outcomes |
| title | Comparison of magnetic resonance‐guided laser interstitial thermal therapy corpus callosum ablation to open microsurgical corpus callosotomy: A single‐center retrospective cohort study |
| title_full | Comparison of magnetic resonance‐guided laser interstitial thermal therapy corpus callosum ablation to open microsurgical corpus callosotomy: A single‐center retrospective cohort study |
| title_fullStr | Comparison of magnetic resonance‐guided laser interstitial thermal therapy corpus callosum ablation to open microsurgical corpus callosotomy: A single‐center retrospective cohort study |
| title_full_unstemmed | Comparison of magnetic resonance‐guided laser interstitial thermal therapy corpus callosum ablation to open microsurgical corpus callosotomy: A single‐center retrospective cohort study |
| title_short | Comparison of magnetic resonance‐guided laser interstitial thermal therapy corpus callosum ablation to open microsurgical corpus callosotomy: A single‐center retrospective cohort study |
| title_sort | comparison of magnetic resonance guided laser interstitial thermal therapy corpus callosum ablation to open microsurgical corpus callosotomy a single center retrospective cohort study |
| topic | atonic seizures laser ablation pediatric drug‐resistant epilepsy seizure outcomes |
| url | https://doi.org/10.1002/epi4.12835 |
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