Abstract
Background
Corpus callosotomy is an effective, relatively low-risk, palliative procedure for a selected population of patients with medically intractable epilepsy. Here we describe this technique.
Method
An interhemispheric microsurgical approach is performed. Neuronavigation facilitates orientation. The callosal body is transected through to the roof of the ipsilateral ventricle using an ultrasonic aspirator; the genu and rostrum are then identified and also split. If a total callosotomy is performed, transection of the splenium is performed with care given to preserve the crus of the fornix.
Conclusions
Meticulous microsurgical technique and knowledge of the limbic system’s anatomy is essential to keeping this procedure safe and effective.
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10 key points
- Best indicated in medically intractable tonic and atonic seizures with drop attacks
- Use neuronavigation and ultrasonic aspirator
- Consider the venous anatomy (bridging veins)
- Start anteriorly
- Avoid traction on the central region and on the cingulate gyri
- Clearly identify the pericallosal cistern
- Enter the ipsilateral lateral ventricle and identify the rostrum (navigate!)
- Coagulate ependymal veins
- Identify splenium and do not stop resection until full visualisation of arachnoid of deep venous angle
- Connect with the posterior border of anterior callosotomy
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A right-sided interhemispheric microsurgical approach is performed through a midline craniotomy along the long axis of the corpus callosum. Neuronavigation is used to help in orientation. The callosal body is transected through to the roof of the ipsilateral ventricle, followed by the transection of the genu and rostrum, the posterior callosal body and, finally, the splenium, which is split down to the velum interpositum, with care given to preserving the crus of the fornix. (M4V 82594 kb)
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Schaller, K., Cabrilo, I. Corpus callosotomy. Acta Neurochir 158, 155–160 (2016). https://doi.org/10.1007/s00701-015-2619-x
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DOI: https://doi.org/10.1007/s00701-015-2619-x