AI Article Synopsis
- Tonic and atonic drop attack seizures are common and problematic in Lennox-Gastaut syndrome, leading to injuries and cognitive issues, and there's increasing interest in safer surgical options like corpus callosotomy.
- A 5-year-old boy with severe seizures underwent a fully endoscopic transventricular corpus callosotomy due to risks associated with traditional surgical methods, resulting in fewer and less intense seizures and improved quality of life reported by his family.
- This technique may offer a safer alternative for patients with drug-resistant seizures and abnormal brain anatomy, reducing potential complications during surgery.
Article Abstract
Background: Tonic and atonic "drop attack" seizures are a classic and morbid semiology in Lennox-Gastaut syndrome, resulting in frequent injuries and emergency room visits, in addition to neurocognitive sequelae. Recent years have seen a growing interest in less invasive techniques for performing the classic surgical treatment for drop attacks in Lennox-Gastaut syndrome, that is, corpus callosotomy.
Observations: A 5-year-old boy with Lennox-Gastaut syndrome presented for surgical evaluation. He experienced up to 20 daily tonic seizures despite multiple antiseizure medications. Preoperative imaging revealed highly abnormal anatomy with severe ventriculomegaly and thinning of the cortex and corpus callosum. Open microsurgery or an interhemispheric bimanual endoscopic approach to corpus callosotomy posed a risk for ventricular collapse and subdural hematoma, and the corpus callosum was too thin for laser ablation. A fully endoscopic transventricular "inside-out" complete corpus callosotomy was performed through a 7-mm burr hole via a single working channel without intraoperative complications. The patient continues to experience daily seizures but with a reduced frequency and intensity and a family-reported increased quality of life.
Lessons: In cases of drug-resistant tonic and atonic seizures associated with ventriculomegaly, a fully endoscopic transventricular complete corpus callosotomy can be performed safely, potentially limiting the risk of ventricular collapse and subdural bleeding. https://thejns.org/doi/10.3171/CASE24160.
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| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC11373692 | PMC |
| http://dx.doi.org/10.3171/CASE24160 | DOI Listing |
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