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Posterior Quadrant Disconnection: A Fiber Dissection Study.

Alexander Verhaeghe1, Thomas Decramer1, Wim Naets1

  • 1Department of Neurosurgery, University Hospitals Leuven, Leuven, Belgium.

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|December 19, 2017
PubMed
Summary
This summary is machine-generated.

Posterior quadrant disconnection surgery effectively treats refractory epilepsy by isolating the temporoparietooccipital cortex. This procedure requires sectioning the posterior one-third of the corpus callosum for optimal outcomes.

Keywords:
CallosotomyDisconnective surgeryEpilepsy surgeryKlingler's fiber dissectionNeuroanatomyPosterior cortex epilepsyPosterior quadrant surgery

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Area of Science:

  • Neurosurgery
  • Epileptology
  • Neuroanatomy

Background:

  • Refractory epilepsy can be treated with posterior quadrant disconnection.
  • This surgical technique isolates the temporoparietooccipital cortex to deafferent epileptogenic posterior cortex.

Purpose of the Study:

  • To describe the posterior quadrant disconnection procedure.
  • To detail relevant white matter tracts, emphasizing corpus callosum sectioning extent.
  • Anatomic study of white matter tracts involved in posterior epilepsy surgery.

Main Methods:

  • Utilized Klingler's fiber dissection technique on twenty hemispheres.
  • Illustrated peri-insular white matter tracts (temporal stem, superior longitudinal fasciculus, corona radiata).
  • Detailed mesial disconnection including mesiotemporal cortex, cingulum, and corpus callosum.

Main Results:

  • Posterior quadrant disconnection achieves extensive white matter tract isolation.
  • Callosal fibers in the corpus callosum's isthmus connect to the anterior parietal cortex and require disconnection.
  • Frontal lobe connections, corticospinal tract, and anterior two-thirds of the corpus callosum remain intact.

Conclusions:

  • Findings indicate splenium and isthmus involvement in interhemispheric propagation for posterior cortex epilepsies.
  • Complete sectioning of the posterior one-third of the corpus callosum may be essential.
  • Optimizing outcomes in posterior quadrant epilepsy surgery may necessitate extensive callosotomy.