Image-guided posterior callosotomy: Optimizing disconnection with DTI tractography and neuronavigation

Area of Science:

• Neurosurgery
• Epileptology
• Medical Imaging

Background:

• Corpus callosotomy is a palliative treatment for drug-refractory epilepsy with drop attacks.
• Traditional methods lack precision, leading to variable outcomes and cognitive deficits.
• Advances in tractography and neuronavigation offer improved surgical targeting.

Purpose of the Study:

• To assess the safety, efficacy, and feasibility of tractography-guided neuronavigation in posterior callosotomy.
• To optimize the disconnection of motor fibers for enhanced seizure control.
• To evaluate the impact on cognitive function and surgical precision.

Main Methods:

• Retrospective study of six patients with refractory epilepsy and drop attacks.
• Preoperative MRI tractography integrated into a neuronavigation system.
• Intraoperative neuronavigation with superimposed tractography for precise motor fiber transection.

Main Results:

• Complete motor fiber sectioning achieved in 4 patients (100%), partial in 2 (82.1%, 89.26%).
• Complete sectioning led to 100% drop attack reduction; partial sectioning resulted in 75-85.7% reduction.
• No motor deficits or complications; comparable operative duration; stable or improved cognitive outcomes.

Conclusions:

• Tractography-guided neuronavigation in posterior callosotomy is feasible and safe.
• This approach enhances surgical precision, leading to superior seizure control.
• Fiber-informed neuronavigation personalizes and optimizes outcomes for epilepsy surgery.