title: Outcome after anterior callosal section that spares the splenium in pediatric patients with drop attacks.
abstract: We report on the efficacy and safety of extended, one-stage anterior callosal section that spares the splenium, which is performed in a large series of pediatric patients with drop attacks. Twenty-nine pediatric patients with drop attacks were studied (19 males and 10 females; mean age: 9.9 years). As presurgical factors, the age at surgery, age at seizure onset, age at drop attack onset, sex, hemiparesis, severe mental retardation, electroencephalograph abnormalities, magnetic resonance imaging abnormalities, and (18)fluorodeoxyglucose positron emission tomography abnormalities were analyzed. All patients had multiple seizure types, including drop attacks, atypical absence seizures, complex partial seizures, tonic seizures, and generalized tonic-clonic seizures. All patients were developmentally impaired and had electroencephalograph results showing marked secondary bilateral synchrony. All patients received an extended, one-stage callosal section, leaving only the splenium intact. The mean follow-up time was 5.2 years. Seizure outcome (cessation of seizures or ≥ 90% seizure reduction) was achieved in 79.3% of patients with drop attacks. The families assessed the overall daily function as improved in 62.1% of the patients, unchanged in 24.1%, and worse in 13.8%. Family satisfaction with callosotomy was achieved in 82.8% of the patients. The majority of the patients had some degree of a transient acute postoperative disconnection syndrome that disappeared within 3 weeks. Postoperatively, patients showed a consistent increase in attention levels. We conclude that extended callosal sectioning that leaves the splenium intact should be considered a good palliative surgical option for pediatric patients with drop attacks and that diminishment of epileptic discharge synchrony is a good prognostic sign following callosotomy. We also found that the postoperative increase in attention levels was as useful as seizure control in improving the quality of life of these patients.
authors.affiliation: Department of Neurosurgery, Fuzhou General Hospital of Nanjing Command, PLA, Fuzhou 350025, China. Electronic address: yangpengfan@outlook.com.
authors.forename: Peng-Fan
authors.initials: PF
authors.lastname: Yang
authors.affiliation: Department of Epileptology, Fuzhou General Hospital of Nanjing Command, PLA, Fuzhou 350025, China.
authors.forename: Qiao
authors.initials: Q
authors.lastname: Lin
authors.affiliation: Department of Epileptology, Fuzhou General Hospital of Nanjing Command, PLA, Fuzhou 350025, China.
authors.forename: Zhen
authors.initials: Z
authors.lastname: Mei
authors.affiliation: Department of Medical Imaging, Fuzhou General Hospital of Nanjing Command, PLA, Fuzhou 350025, China.
authors.forename: Zi-Qian
authors.initials: ZQ
authors.lastname: Chen
authors.affiliation: Department of Neurosurgery, Fuzhou General Hospital of Nanjing Command, PLA, Fuzhou 350025, China.
authors.forename: Hui-Jian
authors.initials: HJ
authors.lastname: Zhang
authors.affiliation: Department of Neurosurgery, Fuzhou General Hospital of Nanjing Command, PLA, Fuzhou 350025, China.
authors.forename: Jia-Sheng
authors.initials: JS
authors.lastname: Pei
authors.affiliation: Department of Neurosurgery, Fuzhou General Hospital of Nanjing Command, PLA, Fuzhou 350025, China.
authors.forename: Jun
authors.initials: J
authors.lastname: Tian
authors.affiliation: Department of Epileptology, Fuzhou General Hospital of Nanjing Command, PLA, Fuzhou 350025, China.
authors.forename: Yan-Zeng
authors.initials: YZ
authors.lastname: Jia
authors.affiliation: Department of Epileptology, Fuzhou General Hospital of Nanjing Command, PLA, Fuzhou 350025, China.
authors.forename: Zhong-Hui
authors.initials: ZH
authors.lastname: Zhong
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003071:Cognition / Q000502:physiology; D003337:Corpus Callosum / Q000601:surgery*; D004569:Electroencephalography; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D019635:Neurosurgical Procedures; D010372:Pediatrics; D049268:Positron-Emission Tomography; D012189:Retrospective Studies; D013575:Syncope / Q000000981:diagnostic imaging / Q000601:surgery*; D015898:Tomography Scanners, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D019788:Fluorodeoxyglucose F18
keywords: Drop attacks; Extended callosotomy; Neurosurgery; Outcome; Pediatric epilepsy