Summary
During the past 10 years, 20 patients with intractable generalized, generalized and partial, and partial seizures have been treated here by surgical division of one or more of the forebrain commissures. Modifications in the operative technique and extent of operation have resulted in continued good results in seizure control with decreased morbidity. The present operation, a two-stage division of the corpus callosum and underlying hippocampal commissure, is demonstrated to be effective in controlling intractable seizures. Good or excellent results account for more than 80 per cent of the series. Historical background, indications for operation, criteria for patient selection, operative technique, results, complications, and the value of forebrain commissurotomy as a research tool are presented.
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Akelaitis, A. J., A study of gnosis, praxis, and language following section of the corpus callosum and anterior commissure. J. Neurosurg.1 (1944), 94–102.
Bogen, J. E., Fisher, E. D., Vogel, P. J., Cerebral commissurotomy a second case report. J.A.M.A.194 (1965), 160–161.
Bogen, J. E., Sperry, R. W., Vogel, P. J., Commissural section and propagation of seizures. In: Basic mechanisms of the epilepsies (Jasper, H. H., Ward, A. A., Pope, A., eds.), pp. 439–440. Boston: Little, Brown. 1969.
Bogen, J. E., Vogel, P. J., Cerebral commissurotomy in man. Bull. Los Angeles Neurol. Soc.27 (1965), 169–172.
Crandall, P. H., Postoperative management and criteria for evaluation. In: Neurosurgical management of the epilepsies. Advances in neurology, Vol. 8 (Purpura, D. P., Penry, J. K., Walter, R. D., eds.), pp. 265–279. New York: Raven Press. 1975.
Erickson, T. C., Spread of the epileptic discharge: an experimental study of after discharge induced by electrical stimulation of cerebral cortex. Arch. Neurol. Psychiat.43 (1940), 429–452.
Gazzaniga, M. S., le Doux, J., The integrated mind. New York: Plenum Press. 1978.
Gazzaniga, M. S., le Doux, J. E., Wilson, D. H., Language, praxis and the right hemisphere: clues to some mechanisms of consciousness. Neurology (Minneap.)27 (1977), 1144–1147.
Gazzaniga, M. S., Risse, G. L., Springer, S. P., Clark, E., Wilson, D. H., Psychologic and neurologic consequences of partial and complete cerebral commissurotomy. Neurology (Minneap.)25 (1975), 10–17.
Geschwind, N., Disconnexion syndromes in animals and man. Brain88 (1965), 237–294 and 585–644.
Gordon, H. W., Bogen, J. E., Sperry, R. W., Absence of deconnexion syndrome in two patients with partial section of the neocommissures. Brain94 (1973), 327–336.
Harbaugh, R. E., Wilson, D. H., Telencephalic theory of generalized epilepsy: observations in split-brain patients. Neurosurgery10 (1982), 725–732.
Horsley, V., Abstract of the Brown lectures. Epilepsy lectures III–V. Lancet2 (1886), 1211–1213.
Le Doux, J. E., Risse, G. L., Springer, S. P., Wilson, D. H., Gazzaniga, M. S., Cognition and commissurotomy. Brain100 (1977), 87–104.
Luessenhop, A. L., Interhemispheric commissurotomy as an alternative to hemispherectomy for control of intractable seizures. Am. Surg.36 (1970), 265–268.
Luessenhop, A. J., de la Cruz, T. C., Fernichel, G. M., Surgical disconnection of the cerebral hemispheres for intractable seizures. J.A.M.A.213 (1970), 1620–1636.
Marcus, E. M., Watson, C. W., Bilateral synchronous electrographic patterns in the cat: interaction of bilateral cortical foci in the intact, the bilateral cortical-callosal and adiencephalic preparation. Arch. Neurol.14 (1966), 601–610.
Marcus, E. M., Watson, C. W., Bilateral symmetrical epileptogenic foci in monkey cerebral cortex. Arch. Neurol.19 (1968), 99–116.
Naquet, R., Menini, C., Catier, J., Photically induced epilepsy inPapio papio. The initiation of discharges and the role of the frontal cortex and of the corpus callosum. In: Synchronization of EEG activity in epilepsies (Petsche, H., Brazier, M. A. B., eds.), pp. 347–367. Wien-New York: Springer. 1972.
Sperry, R. W., Gazzaniga, M. S., Bogen, J. E., Interhemispheric relationships: the neocortical commissures; syndromes of hemisphere disconnection. In: Handbook of clinical neurology, Vol. 4 (Vinken, P. J., Bruyn, G. W., eds.), pp. 273–290. Amsterdam: North Holland Publishing Company. 1969.
Torres, F., French, L. A., Acute effect of section of the corpus callosum upon “independent” epileptiform activity. Acta Neurol. Scand.49 (1973), 47–62.
Udvarhelyi, G. B., Walker, A. E., Dissemination of acute focal seizures in the monkey. I. From cortical foci. Arch. Neurol.12 (1965), 333–356.
Van Wagenen, W. P., Herren, R. Y., Surgical division of commissural path-ways in the corpus callosum. Arch. Neurol.44 (1940), 740–759.
Walker, A. E., Udvarhelyi, G. B., The generalization of a seizure. J. Nerv. Ment. Dis.140 (1965), 252–271.
Wilson, D. H., Limited exposure in cerebral surgery. J. Neurosurg.34 (1971), 102–106.
Wilson, D. H., Culver, C., Waddington, M., Gazzaniga, M., Disconnection of the cerebral hemispheres. An alternative to hemispherectomy for the control of intractable seizures. Neurol.25 (1975), 1149–1153.
Wilson, D. H., Reeves, A., Gazzaniga, M., Division of the corpus callosum for uncontrollable epilepsy. Neurol.28 (1978), 649–653.
Wilson, D. H., Reeves, A., Gazzaniga, M., Corpus callosotomy for control of intractable seizures. In: Advances in epileptology: the tenth epilepsy international symposium (Wada, J. A., Penry, J. K., eds.), pp. 205–213. New York: Raven Press. 1980.
Wilson, D. H., Reeves, A., Gazzaniga, M., Culver, C., Cerebral commissurotomy for control of intractable seizures. Neurol.27 (1977), 708–715.
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Harbaugh, R.E., Wilson, D.H., Reeves, A.G. et al. Forebrain commissurotomy for epilepsy. Acta neurochir 68, 263–275 (1983). https://doi.org/10.1007/BF01401184
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DOI: https://doi.org/10.1007/BF01401184