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

In a single-patient illustrative case. Mine et al. from the Kyushu University, Fukuoka, Japan. poblished in the Journal of Neurosurgery Case Lessons, to report on the first adult case of Dentatorubral-pallidoluysian atrophy (DRPLA)-associated progressive myoclonic epilepsy (PME) undergoing total corpus callosotomy (CC) for refractory seizures. Total CC led to a marked reduction in seizure frequency; tonic seizures and FBTCSs with desaturation resolved by 1 year, improving QOL ¹⁾.

• Strengths:

– Novelty: First reported adult DRPLA-PME CC case.

  – Clear epilepsy burden: Longstanding myoclonus, tonic seizures, status epilepticus with oxygen desaturation.  
  – Intervention and outcome: Rapid seizure control post-CC, with sustained benefit at 1-year follow-up.

• Limitations:

– Single case—limited generalizability.

  – No control, no comparative analysis vs. anterior CC or other modalities.  
  – Cognitive trajectory not objectively quantified pre- vs. post-op.  
  – DRPLA is diffuse; CC addresses interhemispheric spread rather than epileptogenic focus.

• Intellectual Rigour:

– Authors correctly acknowledge palliative intent.

  – Background supported by PME CC precedent in pediatric and non-DRPLA cohorts :contentReference[oaicite:1]{index=1}.  
  – However, literature discussion could further weigh alternative interventions (thalamic stimulation, VNS).

• Clinical Verdict:

– Verdict: 6/10 – Interesting and well-documented, but lacks broader context and rigorous outcome measures.

• For adult DRPLA patients with refractory PME and severe daily seizures, total CC can be a viable palliative option.
• Offers rapid seizure reduction and improved oxygenation and QOL without major additional harm.

Total corpus callosotomy may be effective palliative therapy in adult-onset DRPLA-related PME when conventional treatments fail.

• Title: Total corpus callosotomy for an adult patient with progressive myoclonic epilepsy associated with dentatorubral-pallidoluysian atrophy: illustrative case
• Full citation: Mine D, et al. J Neurosurg Case Lessons. 2025 Jul 7;10(1):CASE2576. doi:10.3171/CASE2576.
• Publication date: July 7, 2025

Case Report, Epilepsy Surgery, DRPLA, Corpus Callosotomy

PME, DRPLA, callosotomy, adult epilepsy, palliative neurosurgery, case lessons