Dr. Ramesh Doddamani Podcast

This video demonstrates the surgical technique of endoscopic total corpus callosotomy combined with pan-commissurotomy for the treatment of drug-resistant Lennox–Gastaut syndrome (LGS), a severe form of childhood-onset epilepsy characterized by multiple seizure types, cognitive impairment, and resistance to antiseizure medications.

Corpus callosotomy is a palliative disconnection procedure that interrupts the corpus callosum, the major commissural pathway connecting the two cerebral hemispheres. The addition of pan-commissurotomy involves disconnection of other interhemispheric commissures, including the anterior commissure and hippocampal commissure, to further prevent seizure propagation between hemispheres.

Using a minimally invasive endoscopic approach, the surgeon accesses the lateral ventricle and visualizes the corpus callosum under direct magnification. The procedure involves careful identification of anatomical landmarks, including the pericallosal arteries, septum pellucidum, and ventricular structures, followed by complete disconnection of the corpus callosum from the genu to the splenium. Additional commissural fibers are disconnected to achieve comprehensive interhemispheric disconnection.

This minimally invasive endoscopic technique offers several advantages compared to traditional open microsurgical approaches, including reduced brain retraction, improved visualization, smaller craniotomy, faster recovery, and reduced surgical morbidity.

Endoscopic total corpus callosotomy with pan-commissurotomy is an effective surgical option for reducing seizure frequency and severity, particularly drop attacks, in patients with Lennox–Gastaut syndrome and other forms of generalized drug-resistant epilepsy.