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.

• 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

• Approach: Interhemispheric via midline craniotomy
• Procedure:
  1. Dissection through the interhemispheric fissure
  2. 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

• 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

• Disconnection syndromes:
  1. Left-hand apraxia
  2. Alexia without agraphia
  3. Alien hand phenomenon
• Transient speech and motor deficits
• Rare: infection, hemorrhage, hydrocephalus

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