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Semin Neurol 2025; 45(02): 241-251
DOI: 10.1055/a-2538-3354
Review Article

Disconnection Methods in the Surgical Treatment of Epilepsy

Runze Yang
1   Section of Neurosurgery, Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
,
Goichiro Tamura 
2   Department of Neurosurgery, University of Tsukuba Hospital, Tsukuba, Japan
,
Julia Jacobs
3   Section of Neurology, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
4   Alberta Children's Hospital and Research Institute, University of Calgary, Calgary, Alberta, Canada
,
Walter Hader
1   Section of Neurosurgery, Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
4   Alberta Children's Hospital and Research Institute, University of Calgary, Calgary, Alberta, Canada
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Funding None.
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Abstract

Disconnection procedures in epilepsy surgery have become an important tool for the management of multifocal drug-resistant epilepsy. In this chapter, we will review their indications, describe the technical procedures, and review outcome data in the literature. Among the curative approaches, anterior quadrant disconnection, posterior quadrant (PQ) disconnection, and functional hemispherectomy can be performed for patients whose epileptic focus resides in one hemisphere or one quadrant. Seizure freedom rates from these procedures range from 50 to 81% for anterior quadrant disconnections, 50 to 92% for PQ disconnections, and 43 to 93% for hemispherectomy. Although typically performed in the pediatric population, data suggest that carefully selected adult patients could also benefit from a disconnection procedure. Of the palliative approaches, corpus callosotomy has been shown to be effective for drop attacks, resulting in significant improvement in seizure frequency, severity, and quality of life. Minimally invasive alternatives to standard open corpus callosotomies with laser interstitial thermal therapy (LITT) have been proposed. Overall, surgical disconnection procedures are an effective way of treating multifocal epilepsy, with good outcomes that can improve the quality of life for these patients.

Keywords

epilepsy - disconnection - surgery


Publication History

Article published online:
10 March 2025

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