Total Corpus Callosotomy [Neurosurgery Wiki]

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====== Total Corpus Callosotomy ======

**Total corpus callosotomy** is a neurosurgical procedure that involves complete severing of the **corpus callosum**, the major fiber tract connecting the two cerebral hemispheres, to prevent the spread of epileptic discharges across hemispheres.

===== Indications =====
  * Medically refractory **generalized epilepsy**
  * Frequent and injurious **drop attacks** (atonic seizures)
  * **Lennox-Gastaut syndrome**
  * **Tonic/tonic-clonic seizures** not amenable to resective surgery
  * Intractable epilepsy in **children with diffuse encephalopathies**

===== Surgical Technique =====
  * **Approach**: Interhemispheric via midline craniotomy
  * **Procedure**:
    - Dissection through the **interhemispheric fissure**
    - Identification and complete sectioning of the **corpus callosum**:
      * Genu (anterior)
      * Body (mid)
      * Splenium (posterior)
  * **Staged option**: Anterior 2/3 callosotomy first; splenium later if needed

===== Outcomes =====
  * Seizure reduction in **60–80%** of patients
  * Most effective against **atonic (drop) seizures**
  * Often reduces frequency and severity of generalized seizures
  * **Improves quality of life**, reduces risk of falls and injuries

===== Complications =====
  * **Disconnection syndromes**:
    - Left-hand **apraxia**
    - **Alexia without agraphia**
    - **Alien hand phenomenon**
  * Transient **speech and motor deficits**
  * Rare: infection, hemorrhage, hydrocephalus

===== Clinical Notes =====
  * Not curative, but highly beneficial in selected cases
  * Requires careful **multidisciplinary evaluation**
  * Particularly valuable when **epileptogenic zone is not localizable**