J Neurosurg Pediatr. 2025 Nov 14:1-10. doi: 10.3171/2025.7.PEDS25232. Online ahead of print.
ABSTRACT
OBJECTIVE: Although total corpus callosotomy (TCC) is attempted for better seizure control in patients with drug-resistant generalized seizures and intellectual disability, some surgeons may avoid TCC for fear of postoperative neurocognitive sequelae. The present study aimed to identify the predictors of favorable or unfavorable seizure outcomes and evaluate the postoperative changes in cognitive function after TCC.
METHODS: The authors retrospectively reviewed the clinical records of consecutive patients who underwent TCC to palliate generalized seizures between 2010 and 2022 in the Department of Neurosurgery, Hiroshima University Hospital and had a minimum follow-up of 2 years. The inclusion criteria were 1) age at surgery ≥ 5 years, 2) preoperative IQ score ≤ 50; and 3) 1- or 2-stage TCC. A multivariable logistic regression analysis was performed to determine the predictors of seizure outcome after TCC. The changes in IQ were compared between the favorable and unfavorable seizure outcome groups.
RESULTS: The authors included 40 patients. Favorable seizure outcomes (> 75% reduction in seizure frequency, severity, or both) were obtained after TCC in 29 (72.5%) and 23 (57.5%) patients at 1 year and 2 years postoperatively, respectively. Multivariable logistic regression analysis revealed that interictal electroencephalography showing multiple independent spike foci (MISF) was an independent predictive factor of an unfavorable seizure outcome at 2 years after TCC (p = 0.0270; OR 6.48, 95% CI 1.24-33.96). ΔIQ from preoperatively to 1 year postoperatively was significantly higher in the favorable seizure outcome group (median 0, range -1 to +14) than in the unfavorable seizure outcome group (median -6, range -14 to -5; p = 0.0042). From 1 to 2 years postoperatively, there was no decline in IQ in either group and no difference in ΔIQ between the two groups.
CONCLUSIONS: The authors found that MISF is a predictor of unfavorable seizure outcome after TCC. Unfavorable seizure outcomes are associated with postoperative aggravation in cognitive function. The cognitive deterioration may be due in part to the surgical intervention itself. Thus, appropriate selection of the candidates for TCC is desired.
PMID:41237395 | DOI:10.3171/2025.7.PEDS25232
