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During corpus callosotomy, the patient is under general anesthesia, lying on the back. The head is fixed in place with blunt pins attached to a rigid structure. The head is shaved either before or during the procedure.
Incisions are made in the top of the skull to remove a flap of bone, exposing the brain. The outer covering is cut, and the two hemispheres are pulled slightly apart to expose the corpus callosum. The fibers of the corpus callosum are cut, taking care to avoid nearby arteries and ventricles (fluid-filled cavities in the brain).
Once the cut is made and any bleeding is controlled, the brain covering, bone, and scalp are closed and stitched.
Corpus callosotomy is used to treat epilepsy that is unresponsive to drug treatments. A person with epilepsy may be considered a good candidate for one type of epilepsy surgery or another if he or she has seizures that are not adequately controlled by drug therapy, and has tried at least two (perhaps more, depending on the treatment center's guidelines) different anti-epileptic drugs.
What Happens Before a Corpus Callosotomy?
Candidates for corpus callosotomy undergo an extensive pre-surgery evaluation -- including seizure monitoring, electroencephalography (EEG), magnetic resonance imaging (MRI), and positron emission tomography (PET). These tests help the doctor pinpoint where the seizures begin and how they spread in the brain. It also helps the doctor determine if a corpus callosotomy is an appropriate treatment.
What Happens During a Corpus Collosotomy ?
A corpus callosotomy requires exposing the brain using a procedure called a craniotomy. After the patient is put to sleep with anesthesia, the surgeon makes an incision (cut) in the scalp, removes a piece of bone and pulls back a section of the dura, the tough membrane that covers the brain. This creates a "window" in which the surgeon inserts special instruments for disconnecting the corpus callosum. The surgeon gently separates the hemispheres to access the corpus callosum. Surgical microscopes are used to give the surgeon a magnified view of the brain structures.
In some cases, a corpus callosotomy is done in two stages. In the first operation, the front two-thirds of the structure is cut, but the back section is preserved. This allows the hemispheres to continue sharing visual information. If this does not control the serious seizures, the remainder of the corpus callosum can be cut in a second operation. After the corpus callosum is cut, the dura and bone are fixed back into place, and the scalp is closed using stitches or staples.
Corpus callosotomy outcomes
While a corpus callosotomy does not 'cure' the seizures, one half to 2/3rds of properly selected patients enjoy an improvement in seizure frequency and severity. While drop attacks respond most favorably to this operation, other seizure types may also be improved. Major complications from this surgery are rare.
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