Type of Surgery
Last updated: 02/17/2009
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.
The seizures of epilepsy are due to unregulated spreading of electrical activity from one part of the brain to other parts. In many people with epilepsy, this activity begins from a well-defined focal point, which can be identified by electrical testing. Surgical treatment of focal-origin seizures involves removal of the brain region containing the focal point, usually in a procedure called temporal lobectomy. In other people, no focal point is found, or there may be too many to remove individually. These patients are most likely to receive corpus callosotomy.
The purpose of a corpus callosotomy is to prevent spreading of seizure activity from one half of the brain to the other. The brain is divided into two halves, or hemispheres, that are connected by a thick bundle of nerve fibers, the corpus callosum. When these fibers are cut, a seizure that begins in one hemisphere is less likely to spread to the other. This can reduce the frequency of seizures significantly.
The initial surgery may cut the forward two-thirds of the corpus callosum, leaving the rest intact. If this does not provide sufficient seizure control, the remaining portion may be cut.
Corpus callosotomy (or less frequently, callotomy) is a surgical procedure that disconnects the cerebral hemispheres, resulting in a condition called split-brain.
Most modern callosotomies involve only the anterior portion of the corpus callosum, reflecting the fact that the frontal and temporal lobes are the most commonly involved in the genesis of seizures. The deficits from this modified procedure are milder; side-effects have not been found in some patients (although it is very unlikely that none exist).
The corpus callosum is usually severed in order to stop epileptic seizures. Once the corpus callosum is cut, the brain has much more difficulty sending messages between the hemispheres. Although the corpus callosum is the largest white-matter tract connecting the hemispheres, some limited interhemispheric communication is still possible via the anterior commissure and posterior commissure. When tested in particular situations, it is obvious that information transfer between the hemispheres is reduced.
Select comparative data from 1999 to 2006 include a decrease of 14 percent in the number of neurosurgeons in private practice and a decrease of 13 percent in the number of neurosurgeons in solo practice.
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