Although corpus callosotomy has been used since 1940 to treat severe, medically intractable seizure disorders, controversy remains as to when, or even if, the surgery should be performed. Unlike other types of surgical therapy of epilepsy where the epileptic focus is identified and removed, corpus callosotomy is used to interrupt the propagation of epileptic discharges. The procedure is primarily used in patients with secondarily generalized seizures in whom focal resections are not possible. Long-term follow-up studies of post-callosotomy patients are few and flawed by lack of accurate seizure counts and quality-of-life measures. Although it remains difficult to predict those patients who will benefit from the surgery, it appears that patients with "drop" attacks benefit the most from the procedure. (J Child Neurol 1994;9(Suppl):2S50-2S60).
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References
1.
Wyler AR: Corpus callosotomy, in Wyllie E (ed): The Treament of Epilepsy: Principles and Practice. Philadelphia, Lea & Febiger, 1993, pp 1120-1125.
2.
Gates JR: Candidacy for corpus callosum section, in Lüders H (ed): Epilepsy Surgery. New York, Raven Press, 1991, pp 119-130.
3.
Roberts DW, Rayport M., Maxwell RE, Olivier A., Marino R. Jr: Corpus callosotomy, in Engel J Jr (ed): Surgical Treatment of the Epilepsies. 2nd ed. New York, Raven Press, 1993, pp 519-526.
4.
Dandy WE: Operative experiences in cases of pineal tumors. Arch Surg1936;33:19-46.
5.
Van Wagenen WP, Herren RY: Surgical division of commissural pathways in the corpus callosum: Relation to spread of an epileptic attack . Arch Neurol Psychiat1940;44:740-759.
6.
Erickson TE: Spread of the epileptic discharge: An experimental study of the afterdischarge induced by electrical stimulation of the cerebral cortex. Arch Neurol Psychiatry1940;43:429-52.
7.
Taylor DC: Callosal section for epilepsy and the avoidance of doing everything possible . Dev Med Child Neurol1990;32: 267-274.
8.
Spencer SS, Spencer DD, Sass K., et al: Anterior, total, and two-stage corpus callosum section: Differential and incremental seizure responses. Epilepsia1993;34:561-567.
9.
Wyllie E.: Corpus callosotomy for intractable generalized epilepsy. J Pediatr1988;113:255-261.
10.
Gates JR, Leppik IE, Yap J., Gumnit RJ: Corpus callosotomy: Clinical and electroencephalographic effects. Epilepsia1984;25:308-316.
11.
Spencer SS, Spencer DD, Williamson PD, et al: Corpus callosotomy for epilepsy. I. Seizure effects. Neurology1988;38:19-24.
12.
Murro AM, Flanigin HF, Gallagher BB, et al: Corpus callosotomy for the treatment of intractable epilepsy . Epilepsy Res1988;2:44-50.
13.
Spencer SS: Corpus callosum section and other disconnection procedures for medically intractable epilepsy. Epilepsia1988; 29(Suppl 2):S85-S99.
14.
Nordgren RE , Reeves AG, Roberts DW: Corpus callosotomy for intractable seizures in children. Ann Neurol1988;24:316.
15.
Makari GS, Holmes GL, Murro AM, et al: Corpus callosotomy for the treatment of intractable epilepsy in children. J Epilepsy1989;2:1-7.
16.
Sass KJ, Spencer DD, Spencer SS, et al: Corpus callosotomy for epilepsy. II. Neurologic and neuropsychological outcome. Neurology1988;38:24-28.
17.
Fuiks KS, Wyler AR, Hermann BP, Somes G.: Seizure outcome from anterior and complete corpus callosotomy. J Neurosurg1991;74:573-578.
18.
Pandya DN, Rosene DL: Topography of commissural fibers, in Reeves AG (ed): Epilepsy and the Corpus Callosum. New York, Plenum Press, 1985, pp 21-39.
19.
Lent R.: Neuroanatomical effects of neonatal transection of the corpus callosum in hamsters. J Comp Neurol1984;223:548-555.
20.
Salamy A.: Commissural transmission: Maturation changes in humans. Science1978;200:1409-1411.
21.
Ottino CA, Meglio N., Rossi Gff, Tercero E.: An experimental study of the structures mediating bilateral synchrony of epileptic discharges of cortical origin. Epilepsia1971 ;12:299-311.
22.
Mott FW, Schaeffer EA: On movements resulting from faradic excitation of the corpus callosum in monkeys . Brain1890;13: 174-177.
23.
Wada JA: New surgical treatment through experimental models, in Wada JA, Penry K (eds): Advances in Epileptology: The Xth Epilepsy International Symposium. New York, Raven Press , 1980, pp 195-213.
24.
Fukuda H., Wada JA, Riche D., Naquet R.: Role of the corpus callosum and hippocampal commissure on transfer phenomenon in amygdala-kindled cats. Exp Neurol1987;98:189-197.
25.
McIntyre DC , Edson N.: Facilitation of secondary site kindling in the dorsal hippocampus following forebrain bisection. Exp Neurol1987;96:560-579.
26.
McIntyre DC , Stokes KA, Edson N.: Status epilepticus following stimulation of a kindled hippocampal focus in intact and comimissurotomized rats. Exp Neurol1986;94:554-579.
27.
Morrell F.: Physiology and histochemistry of the mirror focus, in Jasper HH, Ward AA , Pope A (eds): Basic Mechanisms of the Epilepsies. Boston, Little Brown and Company, 1969, pp 357-370.
28.
Schwartzkroin PA, Futmachi KJ, Noebels JL, Prince DA: Trans-callosal effects of a cortical epileptiform focus. Brain Res1975;99:59-68.
29.
Isaacson RL , Schwartz H., Persoff N., Pinson L.: The role of the corpus callosum in the establishment of areas of secondary epileptiform activity . Epilepsia1971;12:133-146.
30.
Woodruff ML : Midbrain and callosal influences on the spread of focal cortical epileptic activity. Brain Res1975;85:53-58.
31.
Marcus EM, Watson CW, Simons SA: An experimental model of some varieties of petit mal epilepsy. Electrical behavioral correlations of acute bilateral epileptogenic foci in cerebral cortex. Epilepsia1968;9:233-248.
32.
Musgrave J. , Gloor P.: The role of the corpus callosum in bilateral interhemispheric synchrony of spike and wave discharge in feline generalized penicillin epilepsy. Epilepsia1980;21:369-378.
33.
Wada JA, Mizoguchi TM: Limbic kindling in the forebrain bisected photosensitive baboon, Papio Papio . Epilepsia1984; 25:278-287.
34.
Aicardi J., Chevrie JJ, Rousselie F.: Le syndrome spasmes en flexion, agénésis calleuse, anomalies choriorétiniennes . Arch Fr Pediatr1969;26:1103-1120.
35.
Fariello RG , Chun Rwm , Doro JM, et al: EEG recognition of Aicardi's syndrome . Arch Neurol1977;34:563-566.
36.
Carrazana EJ , Barlow JK, Holmes GL: Infantile spasms provoked by partial seizures. A Case report. J Epilepsy1990;3:97-100.
37.
Carrazana EJ , Lombroso CT, Mikati M., et al: Facilitation of infantile spasms by partial seizures. Epilepsia1993;34:97-109.
38.
Pinard JM, Delalande O., Plouin P., Dulac O.: Callosotomy in West syndrome suggests a cortical origin of hypsarrythmia . Epilepsia1993;34:780-787.
39.
Chugani HT, Shewmon DA, Sankar R., et al: Infantile spasms: II. Lenticular nuclei and brain stem activation on positron emission tomography. Ann Neurol1992;31:212-219.
40.
Fermaglisch J., O'Doherty DS: Agenesis of the corpus callosum: An electroencephalographic study. Epilepsia1972;13:345.
41.
Geoffroy G. , Lassonde M., Delisle F., Decarie M.: Corpus callosotomy for control of intractable epilepsy in children. Neurology1983;33:891-897.
42.
Oguni H., Olivier A., Andermann F., Comair J.: Anterior callosotomy in the treatment of medically intractable epilepsies: A study of 43 patients with a mean follow-up of 39 months. Ann Neurol1991;30:357-364.
43.
Spencer SS, Spencer DD, Williamson PD, Mattson RH: Effects of corpus callosum section on secondary bilaterally synchronous interictal EEG discharges. Neurology1985;35:1689-1694.
44.
Spencer SS: Corpus callosotomy section and other disconnection procedures for medically intractable epilepsy. Epilepsia1988;29(Suppl 2):S85-S99.
45.
Roberts DW, Allen CD, Allen AH, Reeves AG: Depth electrode recording in patients undergoing corpus callosotomy for intractable epilepsy. Appl Neurophysiol1983;46:26-32.
46.
Lieb JP, Babb TL: Interhemispheric propagation time of human hippocampal seizures. II. Relationship to surgical outcome. Epilepsia1986;27:294-300.
47.
Spencer SS, Williamson PD, Spencer DD, Mattson RH: Human hippocampal seizure spread studied by depth and subdural recording: The hippocampal commissure. Epilepsia1987 ;28: 479-489.
48.
Wilson DH, Reeves AG, Gazzaniga MS: "Central" commissurotomy for control of intractable generalized epilepsy: Series two. Neurology1982;32:687-697.
49.
Goldberg WE , Holmes GL, Gould J.: Effects of anterior corpus callosotomy on the electroencephalogram. J Epilepsy1989;2: 73-81.
50.
Lieb JP, Engel JJ, Babb TL: Interhemispheric propagation time of human hippocampal seizures. I. Relationship to surgical outcome. Epilepsia1986;27:286-293.
51.
Gotman J.: Interhemispheric interactions in seizures of focal onset: Data from human intracranial recordings. Electroencephalogr Clin Neurophysiol1987;67:120-133.
52.
Wilson DH, Reeves AG, Gazzaniga M.: Division of the corpus callosum for uncontrollable epilepsy. Neurology1978;28:649-653.
53.
Luessenhop AJ, de la Cruz TC, Fenichel GM: Surgical disconnection of the cerebral hemispheres for intractable seizures: Results in infancy and childhood. JAMA1970;213:1630-1636.
54.
Bogen JE, Vogel PJ: Cerebral commissurotomy in man. Bull Los AngeLesNeurol1962;27:169-172.
55.
Fiol ME, Gates JR, Mireles R., et al: Value of intraoperative changes during corpus callosotomy in amygdala-kindled cats. Exp Neurol1993;34:74-78.
56.
Rappaport ZH , Lerman P.: Corpus callosotomy in the treatment of secondary generalizing epilepsy. Acta Neurochir (Wien)1988;94:9-14.
57.
Gates JR, Rosenfeld WF, Maxwell RE, Lyons RE: Response of multiple seizure types to corpus callosum section. Epilepsia1987;28:28-34.
58.
Williamson PD : Corpus callosum section for intractable epilepsy: Criteria for patient selection, in Reeves AG (ed): Epilepsy and the Corpus Callosum. New York, Plenum Press, 1985, pp 243-257.
59.
Torres F., French LA: Acute effect of section of the corpus callosum upon "independent" epileptiform activity. Acta Neurol Scand1973 ;49:47-62.
60.
Raffel C., Kongelbeck SR, Snead OC: Corpus callosotomy for intractable epilepsy in children. Pediatr Neurosurg1992;18: 305-309.
61.
Rappaport ZH : Corpus callosum section in the treatment of intractable seizures in the Sturge-Weber syndrome. Childs Nerv Syst1988;4:231-232.
62.
Landy HJ, Curless RG, Ramsay RE, et al: Corpus callosotomy for seizures associated with band heterotopia . Epilepsia1993;34:79-83.
63.
Black PM, Holmes G., Lombroso CT: Corpus callosum section for intractable epilepsy in children. Pediatr Neurosurg1992;18: 298-304.
64.
Papo I., Quattrini A., Provinciali L., et al: Callosotomy for the treatment of drug resistant generalized seizures. Acta Neurochir (Wien)1990;50(Suppl):134-135.
65.
Papo I., Quattrini A., Provinciali L., et al: Remarques sur la callosotomie dans le traitement de l'epilepsie pharmaco-resistante. Neurochirurgie1989;35:169-176.
66.
Bogen JE, Schultz DH, Vogel PJ: Completeness of callosotomy shown by magnetic resonance imaging in the long term. Arch Neurol1988;45:1203-1205.
67.
Marino R. Jr, Ragazzo PC: Selective criteria and results of selective partial callostomy, in Reeves PG (ed): Epilepsy and the Corpus Callosum. New York, Plenum Press , 1985, pp 281-301.
68.
Bouvier B., Mercier C., St.Hilaire JM, et al: Anterior callosotomy and chronic depth electrode recording in the surgical management of some intractable seizures. Appl Neurophysiol1983;46:52-56.
69.
Marino R. Jr, Radvany J., Huck FR, et al: Selective electroencephalograhic guided microsurgical callosotomy for refractory generalized epilepsy. Surg Neurol1990;34:219-228.
70.
Gazzaniga MS : Review of the split brain. J Neurol1975;209: 75-79.
71.
Wilson DW, Culver C., Waddington M., Gazzaniga M.: Disconnection of the cerebral hemipsheres: An alternative to hemispherectomy for the control of intractable seizures. Neurology1975;25:1149-1153.
72.
Gordon HW, Bogen JE, Sperry RW: Absence of disconnection in two patients with partial section of the neocommissures . Brain1971;94:327-336.
73.
Trescher JH , Ford FR: Colloid cyst of the third ventricle. Report of a case: Operative removal with section of posterior half of the corpus callosum. Arch Neurol Psychiatry1937 ;37: 959-973.
74.
Aikelaitis Aje : A study of gnosis, praxis, and language following section of the corpus callosum and anterior commissure. J Neurosurg1944;1:94-102.
75.
Ross MK, Reeves AG, Roberts DW: Post commissurotomy mutism. Ann Neurol1984 ;16:114.
76.
Spencer SS, Gates JR, Reeves AG, et al: Corpus callosum section, in Engel J Jr (ed): Surgical Treament of the Epilepsies. New York, Raven Press, 1987, pp 425-444.
77.
Sussman NM, Gur RC, Gur RE, O'Connor MJ: Mutism as a consequence of callosotomy. J Neurosurg1983;59:514-519.
78.
Gelmers HJ: Non-paralytic motor disturbances and speech disorders: The role of supplementary motor area. J Neurol Neurosurg Psychiatry1983;46:1052-1054.
79.
Sass KJ, Novelly RA, Spencer DD, Spencer SS: Post-callosotomy language impairments in patients with crossed cerebral dominance . J Neurosurg1990;72:85-90.
80.
Gazzaniga MS , Risse GL, Springer SP, et al: Psychologic and neurologic consequences of partial and complete cerebral commissurotomy . Neurology1975;25:10-15.
81.
Reeves AG: Behavioral changes following corpus callosotomy. Adv Neurol1991;55:293-300.
82.
Musiek FE, Reeves AG, Baran JA: Release from central auditory competition in the split-brain patients . Neurology1985;35: 983-987.
83.
Levine DN, Calvanio R.: Visual discrimination after lesion of the corpus callosum. Neurology1980;30:21-30.
84.
Gur RE, Gur RC, Sussman NM, et al: Hemispheric control of the writing hand: The effect of callosotomy in a left-hander. Neurology1984;34:904-908.
85.
Risse GL, Gates J., Lund G., et al: Interhemispheric transfer in patients with incomplete section of the corpus callosum. Anatomic verification with magnetic resonance imaging . Arch Neurol1989;46:437-443.
86.
Clark CR, Geffen GM: Corpus callosum surgery and recent memory. A review. Brain1989;112:165-175.
87.
Zaidel E., Sperry RW: Memory impairment after commissurotomy in man. Brain1974;97:263-272.
88.
Campbell AL Jr, Bogen JE, Smith A.: Disorganization and reorganization of cognitive and sensory motor functions in cerebral commissurotomy: Compensatory roles of the forebrain commissures and cerebral hemispheres in man. Brain1981;104: 493-551.
89.
Lassonde M. , Sauerwein H., Geoffroy G., Decarie M.: Effects of early and late transection of the corpus callosum in children. Brain1986 ;109:953-967.
90.
Lassonde M. , Sauerwein H., Chicoine AJ, Geoffroy G.: Absence of disconnection syndrome in callosal agenesis and early callosotomy: Brain reorganization or lack of structural specificity during ontogeny?Neuropsychologia1991;29:481-495.
91.
Lassonde M. , Sauerwein H., McCabe N., et al: Extent and limits of cerebral adjustment to early section of congenital absence of the corpus callosum. Behav Brain Res1988;30:165-181.
92.
Huttenlocher P.: Morphometric study of human cerebral cortex development. Neuropsychologia1990;28:517-527.
93.
Spencer SS, Spencer DD, Glaser GH, et al: More intense focal seizure types after callosal section: The role of inhibition. Ann Neurol1984; 16:686-693.
94.
Kopeloff N. , Kennard MA, Pacella BL, et al: Section of the corpus callosum in experimental epilepsy in the monkey. Arch Neurol Psychiatry1950;63:719-727.
95.
Wada JA, Sato M.: The generalized convulsive seizure state induced by daily electical stimulation of the amygdala in split brain cats. Epilepsia1975;16:417-430.
96.
Mutani R., Durelli L.: Mechanisms of interaction of asymmetrical bilateral epileptogenic foci in neocortex. Epilepsia1980;21: 549-556.
97.
Purves SJ, Wada JA, Woodhurst WB, et al: Results of anterior corpus callosum section in 24 patients with medically intractable seizures. Neurology1988;38:1194-1201.
98.
Awad IA, Wyllie E., Lüders H., Ahl J.: Intraoperative determination of the extent of corpus callosotomy for epilepsy: Two simple techniques. Neurosurgery1990;26:102-106.
99.
Nordgren RE , Reeves AG, Viguera AC, Roberts DW: Corpus callosotomy for intactable seizures in the pediatric age group. Arch Neurol1991 ;48:364-372.
100.
Wilson DH, Reeves A., Gazzaniga M., Culver C.: Cerebral commissurotomy for control of intractable seizures. Neurology1977;27:649-653.
101.
Blume WT: Corpus callosum section: Rationale and review of experimental and clinical data. Cleve Clin J Med1984;51: 319-332.
