Callosotomy Outcomes: A Meta-Analysis.

Abstract

Corpus callosotomy is a palliative surgical intervention for pediatric intractable epilepsy, yet the comparative efficacy and complication profiles of anterior corpus callosotomy (ACC), posterior corpus callosotomy (PCC), and total corpus callosotomy (TCC) remain unclear. This meta-analysis evaluates seizure reduction and postoperative complications across these approaches. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we systematically reviewed 66 studies (1349 patients) from PubMed, Cochrane, and other databases. Outcomes included seizure reduction (Engel/International League Against Epilepsy classifications, a novel seizure frequency score) and complications (disconnection syndrome [DCS] and hydrocephalus, mortality). Random-effects meta-analyses and subgroup comparisons (ACC vs. PCC vs. TCC) were conducted. Pooled analysis (565 patients) revealed no significant difference in seizure scores of 0 (100% reduction) or 1 (>90% reduction) between ACC, PCC, and TCC (χ²[2] = 0.16, P = 0.924). PCC showed the highest reduction in drop attacks (92%) versus ACC (52%) and TCC (58%) (P = 0.03). DCS incidence varied significantly (P = 0.0045), with PCC having the lowest risk (0%), followed by ACC (9%) and TCC (20%). Hydrocephalus was rare (1% TCC, 0% ACC, and PCC), and mortality was negligible (1/1349). Heterogeneity was high (I² > 75%) for most outcomes, likely due to methodological variability. While all corpus callosotomy approaches reduce seizures similarly, PCC may offer superior drop attack control and lower DCS risk. TCC is associated with the highest DCS incidence. These findings underscore the need for standardized reporting to further elucidate potential variation in postoperative complications across corpus callosotomy approaches. Data on seizure reduction indicate surgeon preference in the interim.