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
