When Should Corpus Callosotomy be Offered as Palliative Therapy?

Abstract

Long-Term Seizure Outcome after Corpus Callosotomy: A Retrospective Analysis of 95 Patients. Tanriverdi T, Olivier A, Poulin N, Andermann F, Dubeau F. J Neurosurg 2009;110(2):332–342. OBJECT: The authors report long-term follow-up seizure outcome in patients who underwent corpus callosotomy during the period 1981–2001 at the Montreal Neurological Institute. METHODS: The records of 95 patients with a minimum follow-up of 5 years (mean 17.2 years) were retrospectively evaluated with respect to seizure, medication outcomes, and prognostic factors on seizure outcome. RESULTS: All patients had more than one type of seizure, most frequently drop attacks and generalized tonic-clonic seizures. The most disabling seizure type was drop attacks, followed by generalized tonic–clonic seizures. Improvement was noted in several seizure types and was most likely for generalized tonic–clonic seizures (77.3%) and drop attacks (77.2%). Simple partial, generalized tonic, and myoclonic seizures also benefited from anterior callosotomy. The extent of the callosal section was correlated with favorable seizure outcome. The complications were mild and transient and no death was seen. CONCLUSIONS: This study confirms that anterior callosotomy is an effective treatment in intractable generalized seizures that are not amenable to focal resection. When considering this procedure, the treating physician must thoroughly assess the expected benefits, limitations, likelihood of residual seizures, and the risks, and explain them to the patient, his or her family, and other caregivers.