By: Andrew Yee
Corpus Callosotomy
Corpus callosotomy is a type of surgery for patients who suffer from Atonic Seizures, also known as drop attacks (The Children’s Hospital of Philadelphia, 2019). the surgery is done by dividing the corpus callosum to isolate sections of the brain that cause atonic seizures. The corpus callosum is a bundle of nerve fibers connecting the brain’s left and right sides. By dividing the corpus callosum, the procedure aims to prevent seizures from spreading throughout the brain, limiting the length of attacks and how often they occur (Corpus Callosotomy).
Who is Eligible?
Corpus callosotomy is often a choice for children who have taken prescribed antiepileptic drugs and have seen no results in their medical conditions. This is often referred to as drug-resistant seizures, also known as uncontrolled refractory seizures (Luat et. al., 2017).
The procedure can also be helpful to those who wish to minimize the length/occurrence of atonic seizures or those suffering from seizures that spread throughout both hemispheres of the brain. If you suffer from seizures in a specific brain region, also known as focal seizures, Corpus Callosotomy will not be effective.
Pre-Surgery
Before getting surgery, your healthcare provider may do some tests to determine the seizures’ origin. These tests include an EEG, MRI, or PET scan (Corpus Callosotomy).
EEG
An EEG (electroencephalogram) is often used to track electrical activity in the brain by measuring the electrical impulses in your brain (Electroencephalogram (EEG), 2021).
MRI
An MRI (magnetic resonance imaging) is a medical device that creates images of your organs and tissues throughout your body. It uses magnets that cause your protons to align with the magnetic field. Then radiofrequency is released and the computer captures the energy released from the protons, creating an image. An MRI is painless and is done with you lying in an enclosed space (U.S. Department of Health and Human Services).
PET
A PET (Positron Emission Tomography) is a procedure that measures the metabolic rates of your tissues and organs. If done on your brain, a PET scan will reveal the function of oxygen and glucose in your brain, helping to identify the regions related to your seizures (PET/CT scan, 2021).
How is it performed?
Corpus callosotomy is performed with the patient under anesthesia. Anesthesia will put you asleep, making the procedure painless (The Children’s Hospital of Philadelphia, 2019). The procedure can occur in two different ways:
Conventional Method: This method is first done by the neurosurgeon removing a section of your skull to reveal your brain. The neurosurgeon will then use surgical microscopes to insert special instruments to disconnect the nerve fibers or cut the corpus callosum. The neurosurgeon will then replace the piece of skull that was removed and seal the skin incision (The Children’s Hospital of Philadelphia, 2019).
LITT Procedure: This procedure is done without cutting open your skull. Instead, the neurosurgeon will use laser technology that an MRI guides. The laser will remove/destroy the brain cells that cause seizures while not affecting the surrounding tissue (Bermeo-Ovalle, Koubeissi, & Schuele, 2020).
After Surgery
Conventional Method: After the surgery has been completed, the patient will be monitored by the hospital. The patient will be in intensive care for the first day after surgery and then moved to a monitoring room for a few days. Over the next few weeks, the patient will be allowed to ease back into their daily lives, and if in school, they will be able to return in two to four weeks following surgery (Corpus Callosotomy).
LITT Procedure: The LITT procedure requires less time in the hospital post-surgery. The patient will be monitored for a couple hours after surgery and then released within 1 to 2 days. They will be able to return to normal activities in about two weeks (Bermeo-Ovalle, Koubeissi, & Schuele, 2020).
After both conventional and LITT procedures, the patient will still be expected to take antiseizure medications.
Side Effects
Side effects of the surgery include fatigue, feeling out of it, memory problems, headaches, nausea, and trouble talking (Corpus Callosotomy). Your symptoms should resolve within two months, but to be sure, there will be periodic check-ups after the procedure (Bermeo-Ovalle, Koubeissi, & Schuele, 2020).
Serious problems are rare, but like most surgeries, they can still occur (Corpus Callosotomy). This includes:
- Disconnection Syndrome- where the left and right sides of the body do not move in sync since they are now separated.
- Apraxia & Aphasia- trouble talking, slurred speech, and loss of words
- Strokes
- Brain swelling
Effectiveness
Corpus callosotomy has been shown to improve the occurrence of drop attacks, limiting the frequency by 50-75%. For every 1 in 5 people, Corpus callosotomy ends their seizures, leaving them seizure-free (Corpus Callosotomy).
Conclusion
Corpus Callosotomy is a viable option for those suffering from seizures that spread throughout the brain and are medicine resistant. Corpus callosotomy works by dividing your corpus callosum to prevent seizures from spreading throughout the brain. This highly effective treatment can end your seizures, significantly improving the quality of your life.
Resources:
Bermeo-Ovalle, A., Koubeissi, M., & Schuele, S.U. (2020, February 10). LITT thermal ablation. Epilepsy Foundation. Retrieved November 13, 2022, from https://www.epilepsy.com/treatment/surgery/types/litt-thermal-ablation
Children’s Hospital of Philadelphia (2019, March 18). Corpus callosotomy surgery. Children’s Hospital of Philadelphia. Retrieved November 15, 2022, from https://www.chop.edu/treatments/corpus-callosotomy-surgery
Cleveland Clinic (2021). Corpus callosotomy: How it’s done, risks & benefits, recovery, outlook. Cleveland Clinic. Retrieved November 15, 2022, from https://my.clevelandclinic.org/health/treatments/11546-corpus-callosotomy
Johns Hopkins Medicine (2021, August 8). Electroencephalogram (EEG). Johns Hopkins Medicine. Retrieved from: https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/electroencephalogram-eeg
Luat, A.F., Asano, E., Kumar, A., Chugani, H.T., & Sood, S. (2017, March 8). Corpus callosotomy for intractable epilepsy revisited: The Children’s Hospital of Michigan Series. Journal of Child Neurology. Retrieved November 19, 2022 from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5436305
UCSF Radiology (2021, March 19). PET/CT scan. University of California at San Francisco, Radiology. Retrieved December 7, 2022 from: https://radiology.ucsf.edu/patient-care/services/pet-ct
U.S. Department of Health and Human Services (n.d.). Magnetic Resonance Imaging (MRI). National Institute of Biomedical Imaging and Bioengineering. Retrieved December 7, 2022 from: https://www.nibib.nih.gov/science-education/science-topics/magnetic-resonance-imaging-mri
