Results of anterior corpus callosum section in 24 patients with medically intractable seizures

Abstract

Twenty-four medically refractory seizure patients, who did not qualify for excisional surgery, had anterior two-thirds corpus callosum section. Three to 11 years' postoperative follow-up suggests that this procedure can (1) lateralize a frontal lobe focus, which may lead to subsequent localized excision and (2) significantly reduce seizure frequency and severity in 75% of the patients without giving any permanent neurologic deficits. Patients with an ictal focus confined to one frontal lobe did best (8/8 improved), followed by patients with secondarily generalized seizures and multifocal bilateral foci (5/6 improved). Patients with mental retardation benefited less frequently (5/10 improved), but 4/4 from this group with ictal falls associated with Lennox-Gastaut syndrome did benefit. In this series, the improvements following the anterior partial section were lasting if present at 1 year of follow-up. Anterior corpus callosum section should be considered as a diagnostic (lateralizing) and therapeutic option in appropriately defined medically refractory patients who do not qualify for excisional surgery.

Image-Guided, Frameless Stereotactic Sectioning of the Corpus callosum in Children with Intractable Epilepsy

“…Section of the anterior two-thirds of the corpus callosum resulted in good seizure control in this patient population. Seizure control was similar to that which has been previously reported in the literature [2, 3, 5, 7, 8, 10, 12]. We propose that the use of such navigational and image-guided systems act as valuable intraoperative adjunct for the neurosurgeon performing corpus callosotomies.…”

“…Since then, there has been some controversy as to which procedure is most effective. Some series report similar seizure control with complete and partial callosotomies [7, 8], while others advocate the use of a complete procedure [5, 9]. Some studies do acknowledge that such reported differences may relate to potential differences in the extent of anterior callosotomies [9].…”

Corpus Callosotomy for Treatment of Pediatric Epilepsy in the Modern Era

“…Since the 1960s numerous studies regarding the indication and outcomes of corpus callosotomies have been published [4,5,6,7,8,9]. The goal of a callosotomy procedure is to reduce the frequency and severity of seizures by interrupting common seizure spread pathways.…”

Corpus Callosotomy in Pediatric Intractable Epilepsy: Microsurgical Technique Implication and Variation

“…Many investigators have reported the elimination or reduction of frequency as well as the severity of the drop attacks most effectively compared to any other seizure types. (Gates, Leppik et al 1984;Purves, Wada et al 1988;Nordgren, Reeves et al 1991;Spencer, Spencer et al 1993) Majority of patients with medically intractable seizures without localizing lesions undergoing callosotomy usually comprise of many different types of seizures. Infantile spasm, Lennox-Gastaut Syndrome, and West syndrome are the well known syndromic epilepsy with multiple seizure types that are good candidates for the callosotomy.…”

“…Purves et al supported the anterior callosotomy alone is sufficient for some patients controlling www.intechopen.com Corpus Callosotomy in Pediatric Intractable Epilepsy: Microsurgical Technique,Implication and Variation 135 seizure. (Purves, Wada et al 1988) However, the seizure outcome is far better in total callosotomy compared to partial callosotomy in many series especially in pediatric patients without concerned neuropsychological complications. (Rathore, Abraham et al 2007) We had the same 2-stage callosotomy principle previously as well.…”