Abstract
In 1940, van Wagenen and Herren first proposed the corpus callosotomy (CC) as a surgical procedure for epilepsy. CC has been mainly used to treat drop attacks, which are classified as generalized tonic or atonic seizures. Epileptic spasms (ESs) are a type of epileptic seizure characterized as brief muscle contractions with ictal polyphasic slow waves on an electroencephalogram and a main feature of West syndrome. Resection surgeries, including frontal/posterior disconnections and hemispherotomy, have been established for the treatment of medically intractable ES in patients with unilaterally localized epileptogenic regions. However, CC has also been adopted for ES treatment, with studies involving CC to treat ES having increased since 2010. In those studies, patients without lesions observed on magnetic resonance imaging or equally bilateral lesions predominated, in contrast to studies on resection surgeries. Here, we present a review of relevant literature concerning CC and relevant adaptations. We discuss history and adaptations of CC, and patient selection for epilepsy surgeries due to medically intractable ES, and compared resection surgeries with CC. We propose a surgical selection flow involving resection surgery or CC as first-line treatment for patients with ES who have been assessed as suitable candidates for surgery.
Highlights
In 1940, van Wagenen and Herren [1] first introduced the corpus callosotomy (CC) as a surgical treatment option for patients with medically intractable epilepsy and reported the efficacy of preventing the propagation of focal seizures to the contralateral hemisphere
CC has been applied for the treatment of drop attacks, which were classified into generalized tonic or atonic seizures in the latest classification of seizure types in 2017 by the International League Against Epilepsy (ILAE)
Since 1993, CC has been applied for the treatment of drop attacks; the efficacy of CC in treating patients with epileptic spasms (ES) remains unclear
Summary
In 1940, van Wagenen and Herren [1] first introduced the corpus callosotomy (CC) as a surgical treatment option for patients with medically intractable epilepsy and reported the efficacy of preventing the propagation of focal seizures to the contralateral hemisphere. Van Wagenen and Herren encountered three patients with refractory epilepsy who had decreased seizure frequency or bilateral spreading due to tumors or hemorrhage involving the corpus callosum They undertook disconnection of the corpus callosum in those patients with medically intractable epilepsy, and reported the efficacy of preventing propagation of focal seizures to the contralateral hemisphere (secondary generalization) and developing generalized seizures or loss of consciousness [1]. Two recent studies have reported the use of a posterior 1/2 CC technique, involving disconnection in the splenium, isthmus, and posterior of the body in the corpus callosum, to treat drop attacks [27,28].
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