gms | German Medical Science

Objective: CC in our 12 pts led to postoperative EEG lateralization and recommendation to 2nd surgery in 6 cases. In 3 cases 2nd resective surgery was performed with seizure freedom in one and favorable outcome in 2 patients. Quality of life was improved in 9 cases after CC, therefore 3 pts still waiting for 2nd resective surgeryin case of future aggravation of epilepsy. None of the patients showed negative effects after CC. CC can be a helpful tool in diagnostic work-up of pts with focal epilepsies and bilateral findings in order to provide further surgical treatment options. Regarding quality of life CC is a serious treatment option for selected pts with medically intractable lesional epilepsies.

Methods: 12 pts (f:3; m:9). All severely mentally retarded. Etiology: malformation of cortical development (8), PMG (2), HHE-syndrome (1), herpes encephalitis (1). Bilateral EEG (12/12), bilateral pathology in hrMRI (6/12). Postoperative EEG lateralization (6/12), recommendation to 2nd resective surgery (6/12) 2nd resective surgery performed (3/12): t-p-o resection(1), hemispherotomy(2). Significant improvement of quality of daily life regarding alertness and participation (9/12). Post CC ventriculo-peritoneal shunt was required in 1 pt.

Results: Out of 600 patients who underwent epilepsy surgery between 09/1998 and 11/2017 at the Epilepsy Center for Children and Adolescents, retrospective data of 12 CC patients are presented. All underwent video-EEG long-term monitoring at least once and high resolution MRI. Presurgical diagnostic work up including genetic testing ruled out etiologies other than focal lesional epilepsies.

Conclusion: Epilepsy surgery is a successful treatment option for children with drug resistant lesional epilepsies. Age dependent bilateral/generalized EEG-findings and non lateralizing semiology may blur the electro-clinico-anatomical correlation, which is crucial for successful surgical approach. Rapid lateralization and localization of the epileptogenic zone (EZ) is required in case of high seizure burden and/or developmental delayor cognitive decline. In 12 children with either unilateral lesion and poor electro-clinical-anatomical correlation or suspected bilateral lesion and bilateral EEG we performed a corpus callosotomy (CC) as diagnostic approach to lateralize the EZ.