Stereotactic radiosurgery offers a noninvasive technique for division of the corpus callosum which can confer improved seizure control to patients suffering from frequent atonic seizures due to rapid interhemispheric generalization. This non-invasive approach is well-suited for use in a palliative intervention for improved seizure control in this patient population. This is the first report of radiosurgical completion corpus callosotomy in an adult in the United States.
A 20-year old ambidextrous nonverbal man with a history of refractory generalized epilepsy status post-open anterior corpus callosotomy at age 10, Lennox-Gastaut Syndrome and autism presented after two years of incremental, progressive deterioration in seizure control and behavior including one year. The family decided to pursue stereotactic radiosurgery corpus callosotomy. Under general anesthesia, a volume of interest encompassing a full midsagittal plane of the corpus callosum was defined to deliver 60Gy to the 50% isodose line fully encompassing the target. GammaKnife was used with two isocenters at 90 degrees and one at 110 degrees and isodose lines of 60Gy, 20Gy, and 12Gy. Treatment was carried out without difficulty or complications while the patient remained under close monitoring. The patient was discharged the next day with a two week taper of dexamethasone.
Eight months post-radiosurgical corpus callosotomy, the patient is free of atonic seizures and is ambulatory. In carefully selected cases and with protective radiosurgical planning, SRS for completion corpus callosotomy represents an effective option for refractory seizure control.
Copyright © 2020. Published by Elsevier Inc.