International Journal of Epilepsy 2016; 03(01): 42-62
DOI: 10.1016/j.ijep.2015.12.019
Abstracts
Thieme Medical and Scientific Publishers Private Ltd. 2017

Endoscopic assisted (through a mini craniotomy) corpus callostomy combined with anterior, hippocampal, and posterior commissurotomy in Lennox Gastaut syndrome: A pilot study to establish its safety and efficacy

P Sarat Chandra
,
Ajay Garg
1   Dept of Neurosurgery and Center of Excellence AIIMS, New Delhi, India
,
Chitra Sarkar
1   Dept of Neurosurgery and Center of Excellence AIIMS, New Delhi, India
,
Nilesh Kurwale
1   Dept of Neurosurgery and Center of Excellence AIIMS, New Delhi, India
,
Sarabjit Singh Chibber
,
Madhavi Tripathi
1   Dept of Neurosurgery and Center of Excellence AIIMS, New Delhi, India
,
C S Bal
1   Dept of Neurosurgery and Center of Excellence AIIMS, New Delhi, India
,
Manjari Tripathi
1   Dept of Neurosurgery and Center of Excellence AIIMS, New Delhi, India
› Author Affiliations

Subject Editor:
Further Information

Publication History

Publication Date:
12 May 2018 (online)

Background: Corpus callosotomy (CC) is a palliative procedure especially for Lennox Gastaut semiology without localization with drop attacks.

Objective: To describe endoscopic assisted complete CC combined with anterior, hippocampal and posterior commissurotomy.

Methods: Patients with drug refractory epilepsy (DRE) having drop attacks as predominant seizure type, bilateral abnormalities on imaging, moderate to severe mental retardation. All underwent a complete work up (including MRI).

Results: Patients (n = 16, mean age 11.4 ± 6.4 years, range 6–19 years) mean seizure frequency: 24.5 ± 19.8/days (range 1–60); mean intelligence quotient: 25.23 ± 10.71. All had syndromic diagnosis of Lennox Gastaut syndrome (LGS), with etiologies: hypoxic insult (10), lissencephaly (2), bilateral band heterotropia (2) microgyria and pachygyria (2). Surgery: complete callosotomy and section of anterior and posterior commissure by microscopic approach through a mini craniotomy (11) and endoscopic assisted approach (5). Complications: meningitis (1) hyperammonemic encephalopathy (2) and acute transient disconnection (5). No mortality or long-term morbidity. Mean follow-up: 18 ± 4.7 months (range 16–27 months). Drop attacks stopped in all. Seizure frequency/duration decreased >90% in 10 and >50% in 5, increased in one patient. All patients attained pre-surgical functional levels in 3–6 months. Child behavior checklist scores: no deterioration. Parental questionnaire reported 90% satisfaction, attributing to control of drop attacks. The series was compared retrospectively with age/sex matched cohort (where a callosotomy only was performed), showed better outcome for drop attacks (p < 0.003).

Conclusion: This preliminary study demonstrated efficacy, safety of complete callosotomy with anterior, hippocampal and posterior commissurotomy in LGS (drop attacks) with moderate-severe mental retardation.