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Palliative Surgical Techniques (VNS, Callosotomy)

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Textbook of Pediatric Neurosurgery

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Abstract

Epilepsy management has experienced a drastic change over the last few decades, with earlier intervention and comprehensive epilepsy evaluation resulting in improved outcomes. Curative resective epilepsy surgery is an option in only a subgroup of pharmacoresistant patients, where an epileptogenic focus is localized and amenable to surgical intervention. In the remaining patients with medically refractory epilepsy, palliative epilepsy surgery can be offered. Palliative procedures include corpus callosotomy and vagus nerve stimulation. All patients undergoing palliative neurosurgical intervention should undergo complete preoperative evaluation. This entails a comprehensive epilepsy evaluation involving history, examination, prolonged video-electroencaphalogram, extensive tailored neuroimaging, antiepileptic medication management, and genetic/metabolic evaluation when applicable. The decision on which palliative procedure would be most successful must be based on individual factors of each patient. Recent evidence supports the earlier the surgical intervention in the course of intractable epilepsy, the better the outcome in terms of seizure burden, quality of life and development. In addition, there is a reported reduced risk of postoperative complications with early surgical intervention. We discuss in this chapter the indications, patient selection, anatomic considerations, surgical technique and complications, and outcomes observed in corpus callosotomy and vagus nerve stimulation therapy. We summarize experience with palliative neurosurgical techniques in adult and pediatric patients and discuss the beneficial effects, as well as risks of each procedure.

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Authors and Affiliations

  1. Florida Hospital for Children, Orlando, FL, USA

    James E. Baumgartner & Fatima Q. Ajmal

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  1. James E. Baumgartner
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  2. Fatima Q. Ajmal
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Correspondence to James E. Baumgartner .

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Editors and Affiliations

  1. International Neuroscience Institute, Hannover, Germany

    Concezio Di Rocco

  2. Oakland Medical Center, Oakland, California, USA

    Dachling Pang

  3. University of Toronto Hospital for Sick Children, Toronto, Ontario, Canada

    James T. Rutka

Section Editor information

  1. The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, The University of Toronto, Toronto, ONT, USA

    James Thomas Rutka

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Baumgartner, J.E., Ajmal, F.Q. (2018). Palliative Surgical Techniques (VNS, Callosotomy). In: Di Rocco, C., Pang, D., Rutka, J. (eds) Textbook of Pediatric Neurosurgery. Springer, Cham. https://doi.org/10.1007/978-3-319-31512-6_101-1

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  • DOI: https://doi.org/10.1007/978-3-319-31512-6_101-1

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  • Print ISBN: 978-3-319-31512-6

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