• Sarat P Chandra, Nilesh S Kurwale, Sarabjit Singh Chibber, Jyotirmoy Banerji, Rekha Dwivedi, Ajay Garg, Chandrashekhar Bal, Madhavi Tripathi, Chitra Sarkar, and Manjari Tripathi.
• *Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India;‡Centre of Excellence for Epilepsy, New Delhi, India;§Department of Neurology, All India Institute of Medical Sciences, New Delhi, India;¶Department of Neuroradiology, All India Institute of Medical Sciences, New Delhi, India;‖Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India;#Department of Neuropathology, All India Institute of Medical Sciences, New Delhi, India.
• Neurosurgery. 2016 May 1; 78 (5): 743-51.

BackgroundCorpus callosotomy is a palliative procedure especially for Lennox-Gastaut semiology without localization with drop attacks.ObjectiveTo describe endoscopic-assisted complete corpus callosotomy combined with anterior, hippocampal, and posterior commissurotomy.MethodsPatients with drug refractory epilepsy having drop attacks as the predominant seizure type, bilateral abnormalities on imaging, and moderate to severe mental retardation were included. All underwent a complete workup (including magnetic resonance imaging).ResultsPatients (n = 16, mean age 11.4 ± 6.4 years, range 6-19 years) had a mean seizure frequency of 24.5 ± 19.8/days (range 1-60) and a mean intelligence quotient of 25.23 ± 10.71. All had syndromic diagnosis of Lennox-Gastaut syndrome, with the following etiologies: hypoxic insult (10), lissencephaly (2), bilateral band heterotropia (2), and microgyria and pachygyria (2). Surgery included complete callosotomy and the section of anterior and posterior commissure by microscopic approach through a mini craniotomy (11) and endoscopic-assisted approach (5). Complications included meningitis (1), hyperammonemic encephalopathy (2), and acute transient disconnection (5). There was no mortality or long-term morbidity. Mean follow-up was 18 ± 4.7 months (range 16-27 months). Drop attacks stopped in all. Seizure frequency/duration decreased >90% in 10 patients and >50% in 5 patients, and increased in 1 patient. All patients attained presurgical functional levels in 3 to 6 months. Child behavior checklist scores showed no deterioration. Parental questionnaires reported 90% satisfaction attributed to the control of drop attacks. The series was compared retrospectively with an age/sex-matched cohort (where a callosotomy only was performed), and showed better outcome for drop attacks (P < .003).ConclusionThis preliminary study demonstrated the efficacy and safety of complete callosotomy with anterior, hippocampal, and posterior commissurotomy in Lennox-Gastaut syndrome (drop attacks) with moderate to severe mental retardation.

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