What Is a Corpus Callosotomy?
The
corpus callosum is a band of nerve fibers located deep in the brain
that connects the two halves (hemispheres) of the brain. It helps the
hemispheres share information, but it also contributes to the spread of
seizure impulses from one side of the brain to the other. A corpus
callosotomy is an operation that severs (cuts) the corpus callosum,
interrupting the spread of seizures from hemisphere to hemisphere.
Seizures generally do not completely stop after this procedure (they
continue on the side of the brain in which they originate). However, the
seizures usually become less severe, as they cannot spread to the
opposite side of the brain.
Who Is a Candidate for a Corpus Callosotomy?
A
corpus callosotomy, sometimes called split-brain surgery, may be
performed in people with the most extreme and uncontrollable forms of epilepsy,
when frequent seizures affect both sides of the brain. A serious type
of seizure -- called a drop attack -- often results in the person having
sudden falls with a high risk of injury. In addition, people considered
for corpus callosotomy do not experience improvement after receiving
treatment with anti-seizure medications.
What Happens Before a Corpus Callosotomy?
Candidates for corpus callosotomy undergo an extensive pre-surgery evaluation -- including seizure monitoring, electroencephalography (EEG), magnetic resonance imaging (MRI), and positron emission tomography
(PET). These tests help the doctor pinpoint where the seizures begin
and how they spread in the brain. It also helps the doctor determine if a
corpus callosotomy is an appropriate treatment.
What Happens During a Corpus Collosotomy?
A
corpus callosotomy requires exposing the brain using a procedure called
a craniotomy. After the patient is put to sleep with anesthesia, the
surgeon makes an incision in the scalp, removes a piece of bone and
pulls back a section of the dura, the tough membrane that covers the
brain. This creates a "window" in which the surgeon inserts special
instruments for disconnecting the corpus callosum. The surgeon gently
separates the hemispheres to access the corpus callosum. Surgical
microscopes are used to give the surgeon a magnified view of brain
structures.
In some cases, a corpus callosotomy is
done in two stages. In the first operation, the front two-thirds of the
structure is cut, but the back section is preserved. This allows the
hemispheres to continue sharing visual information. If this does not
control the serious seizures, the remainder of the corpus callosum can
be cut in a second operation. After the corpus callosum is cut, the dura
and bone are fixed back into place, and the scalp is closed using
stitches or staples.
What Happens After a Corpus Collosotomy?
The
patient generally stays in the hospital for two to four days. Most
people having a corpus callosotomy will be able to return to their
normal activities, including work or school, in six to eight weeks after
surgery. The hair over the incision will grow back and hide the
surgical scar. The person will continue taking anti-seizure drugs.
How Effective Is a Corpus Callosotomy?
Corpus
callosotomy is successful in stopping drop attacks in about 50% to 75%
of cases. This can decrease the risk of injury and improve the person's
quality of life.
What Are the Side Effects of Corpus Collosotomy?
The following symptoms may occur after having a corpus collosotomy, although they generally go away on their own:
- Scalp numbness
- Nausea
- Feeling tired or depressed
- Headaches
- Difficulty speaking, remembering things, or finding words
What Are the Risks of a Corpus Callosotomy?
Serious problems are uncommon with a corpus callosotomy, but there are risks, including:
- Risks associated with surgery, including infection, bleeding, and an allergic reaction to anesthesia
- Swelling in the brain
- Lack of awareness of one side of the body
- Loss of coordination
- Problems with speech, such as stuttering
- Increase in partial seizures (occurring on one side of the brain)
- Stroke
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