Callosotomy

Callosotomy, or corpus callosotomy, is a neurosurgical procedure that disconnects the corpus callosum, the major bundle of nerve fibers linking the brain’s two hemispheres. It is a palliative treatment for refractory epilepsy, intended to limit the spread of seizures rather than cure them. The procedure is most often considered when seizures are frequent, disabling, and not adequately controlled by medications, dietary therapies, or other surgical options.

Indications include severe, treatment-resistant generalized or bilateral seizures, particularly atonic (drop) seizures, which can be difficult to manage with drugs alone. It is most commonly performed in children, though adults with intractable epilepsy may be considered.

Techniques vary. Partial callosotomy, usually an anterior two-thirds disconnection, aims to reduce interhemispheric seizure propagation while preserving some callosal connections. Total callosotomy severs nearly the entire corpus callosum and can yield greater seizure reduction but carries higher risk of disconnection symptoms. Subpial transection is a related technique that interrupts cortical connections while sparing the corpus callosum in selected cases.

Outcomes and risks: Seizure reduction, especially for atonic seizures, occurs in a majority of patients. Partial callosotomy often provides meaningful improvement with fewer cognitive effects, whereas complete disconnection has higher rates of seizure reduction but a greater chance of mutism, problems with coordination between hands, and other disconnection-related deficits. General surgical risks include infection, bleeding, hydrocephalus, and rare vascular or neurological complications.

Postoperative care focuses on monitoring, rehabilitation, and long-term seizure management, with outcomes depending on seizure type, extent of disconnection, and individual factors.