Corpus callosotomy for intractable epilepsy: a contemporary series of operative factors and the overall complication rate

Objective: Corpus callosotomy is an effective treatment for atonic seizures in patients with medically refractory epilepsy. A large modern series of corpus callosotomies performed via open craniotomy highlights the importance of establishing contemporary complication rates for this operation as a benchmark for comparison with newer methodologies. The authors' study, therefore, examined operative factors and complication rates for a sample of patients who underwent open microsurgical craniotomy for corpus callosotomy to determine current metrics regarding safety and effectiveness for this procedure.

Methods: The authors retrospectively reviewed institutional data for patients who underwent first-time open callosotomy from 2005 to 2022. Demographic and clinical variables were collected and analyzed with a focus on operative factors and complication rates.

Results: A total of 105 patients were included in the study (mean [range] age 9.39 [0.67-24.17] years); 58.1% (n = 61) were male. One surgeon performed a majority of the operations (n = 80 [76.20%]); 2 other surgeons performed the remaining surgical procedures (21.9% and 1.90%, respectively). In total, 66 complete, 38 subtotal (anterior 70%-99%), and 1 posterior (40%) callosotomies were performed. Blood loss was available for 102 (97.1%) patients (mean [range] 96.67 [10-500] ml). The mean [range] operative time was calculated as 226.76 (45-386) minutes in 76 (72.4%) patients by excluding those patients who underwent concurrent vagal nerve stimulator placement or revision. The operative complication rate was determined to be 6.7% and was comprised of 3 cases of transient pseudomeningocele, 3 wound infections, and 1 delayed intraparenchymal hemorrhage. No venous infarcts were observed on postoperative MRI.

Conclusions: This is the largest single-center series of open callosotomy patients thus far in the literature and describes important updated metrics to help evaluate new techniques being developed for the surgical treatment of atonic seizures in medically intractable epilepsy.