Corpus callosotomy in the treatment of medically intractable secondarily generalized seizures of children
Dennis Spencer, MD
Yale University School of Medicine, Professor and Chief, Section of Neurological Surgery, Yale University School of Medicine, PO Box 3333, New Haven, Connecticut 06510
Susan S. Spencer, MD
CORPUS CALLOSOTOMY has been enthusiastically embraced as a palliative treatment for two types of medically intractable seizure disorders: those generalized seizures other than primary epilepsy, which defy localization, and infantile hemiplegia. In the latter disorder, corpus callosotomy is a substitute for hemispherectomy. Both groups of patients usually have early seizure onset of an unremitting nature. The rationale for this procedure in humans began as an empirical observation by Van Wagenen in 1940, was supported by experimental data in animals by Erickson in the same year, and extended in a small series of patients by Bogen during the next twenty years.1–4
It would be logical that this procedure could be applied to children, but it was 30 years later before the successful use of corpus callosum section in infancy and childhood was described by Luessenhop, primarily as a substitute for hemispherectomy.5,6 The rationale included avoiding the long-term risks of hemisphere resection, such as intracranial hemorrhage and hydrocephalus, while maintaining neurologic functions in the affected hemisphere, such as hand coordination and vision. In Luessenhop's group of four children, this was accomplished without apparent neurologic sequelae. In 1971, using microsurgical technique, Wilson revived corpus callosotomy and gradually moved from total commissurotomy to central commissurotomy (corpus callosum and dorsal hippocampal commissure) as a technique that successfully interrupted secondary seizure generalization and carried a low morbidity and mortality.4 Since the efficacy of this procedure was re-established, however, there have been only two additional reports detailing results in a small number of children.7,8 A growing. . .