Corpus Callosotomy

Corpus callosotomy is an important palliative surgical option for some patients with drugresistant epilepsy, particularly in cases of epileptic encephalopathies with recurrent drop seizures. The major indication for corpus callosotomy is drug-resistant drop seizures, particularly in association with Lennox-Gastaut syndrome. Early use of corpus callosotomy was associated with significant complications such as hemispheric edema, infarction of mesial hemispheric structures and even death. However, modern microsurgical techniques utilizing intraoperative frameless stereotactic neuronavigation have markedly reduced operative morbidity. Structural magnetic resonance imaging is most often used to evaluate the extent of corpus callosotomy. The most extreme complication following corpus callosotomy is the disconnection syndrome with symptoms including apathy, urinary incontinence, difficulty initiation speech, nondominant hemineglect and difficulties with inter-manual transfer tasks. A recent meta-analysis on rates and predictors of seizure outcome after corpus callosotomy, including 1742 patients from 58 studies demonstrated that rates of complete-seizure freedom, and drop-attack freedom were 18.8% and 55.3% respectively.