Reappraisal of corpus callosotomy

Corpus callosotomy is a palliative surgical treatment modality that has gone in and out of favor. The purpose of this review is to summarize the studies of callosotomy in the past years as a treatment for severe drug-resistant epilepsy with traumatizing drop attacks, mostly in children and also in some adults. The aim is also to discuss knowledge gaps and suggest how these could be addressed.

Lately, a number of callosotomy series, mostly retrospective and single center, have included 289 operated patients. A few series have included nonoperated controls; one prospective long-term series is national and population based. Seizure outcome is shown to be comparable to that earlier reported, with best effect against drop attacks. There is no consensus on whether anterior or complete callosotomy is to be preferred. In a meta-analysis of callosotomy versus vagal nerve stimulation, callosotomy led to better seizure outcome. Diffusion tensor imaging may be a promising tool to analyze the completeness of the procedure.

Callosotomy remains an effective palliative procedure. Many unresolved issues, such as prognostic indicators, nonseizure-related outcomes, whether to choose anterior or complete callosotomy, and outcomes and adverse effects in adults, need to be studied in prospective, preferably multicenter studies.