Abstracts

The corpus callosum is the principle pathway linking the cerebral corticies, anatomically and neurophysiologically. Corpus callosotomy (CC) is a palliative surgical procedure used in patients with generalized seizure types. It interrupts bilateral synchrony and is most effective in the treatment of both tonic and atonic seizures. With the introduction of the vagus nerve stimulator, CC has seemingly declined in many epilepsy surgical centers. At our center, though the number of CCs declined in the years 2000 and 2001, in recent years it has regained prominence. We retrospectively reviewed the number of CCs performed between 1995 and March 2005 by a single surgeon (JB). The number of surgeries done on a yearly basis, extent of the procedure (partial versus complete), repeat operations (completion of CC and focal resection after CC) and acute/subacute surgical complications were assessed. The patient[apos]s ages ranged from 18 months to 23 years. Eighty-nine patients had a total of ninety-seven surgeries (8 in 1995; 10 in 1996; 14 in 1997; 12 in 1998; 14 in 1999; 1 in 2000; 0 in 2001; 8 in 2002; 15 in 2003; 12 in 2004; and 4 thus far in 2005). Fifty-five patients had partial CCs, thirty patients had complete CCs, and information was unavailable in four. Seven patients with partial CCs returned for completion after their seizures were not adequately controlled; one of whom had to have two further surgeries. Four cases returned for focal resection after a primary focus was identified post CC. Rare complications included a bone flap infection in 2 children; transient diabetes insipidus in 7 patients; and small frontal lobe infarcts in 3 patients. The operating time from incision to complete closure decreased over time (mean duration of approximately 60 minutes). The duration of the hemi-body neglect/disconnection syndrome seen post CC, has also declined over time. Information on time to discharge was available in patients from 1999. The time to discharge decreased over time from a mean of 8.3 days in 1999 to 5.4 in 2004, suggesting a decrease in complication rate. Our institution has seen a resurgence in the number of CCs performed in recent years. It has been effective in rapidly decreasing or eliminating both tonic and atonic seizures. The overall morbidity has been remarkably low. With good patient selection, using an experienced surgeon, the CC should still be entertained as a palliative procedure in patients with tonic and atonic seizures, primarily in patients with frequent seizure inflicted injuries.