A patient with severe, untreatable epilepsy is treated surgical by callosotomy,

Question

A patient with severe, untreatable epilepsy is treated surgical by callosotomy, which is the complete cutting of the corpus callosum. The patient has no other brain damage, and the surgery was a complete success. After the patient recovers, her epilepsy is significantly better, but she is diagnosed as blind in her left visual hemifield by a board certified neuro-opthalmologist. The doctor tested the patient’s vision by flashing small lights one at a time in the visual field at different locations, and asking the patient to say when they saw a light. This patient never reported seeing a light when flashed in the left visual hemifield, but reported seeing the lights everywhere else in the visual field. Is the patient blind in the left visual field?

Explanation / Answer

No.

The patient is not blind but cannot perceive visual field in his left eye because he is suffering from Hemianopia due to a contra lateral lesion.which is a common occurring during complex procedures like calloastomy.

callosotomy is a palliative procedure to limit or modify tonic/atonic seizures; it rarely makes patients seizure free. The operation results in an 80% average reduction in tonic/atonic seizures resulting in falls, a 50% reduction in generalized tonic and tonic-clonic seizures, and 50% atypical absence seizures (although this seizure type is often difficult to quantify). The seizures still occur as partial seizures, but they do not result in falls. Overall, success rates are similar between children and adults and the effects are usually sustained long term.

After corpus callosotomy, most patients have significant improvement in cognitive function, activities of daily living, and behavior. Outcome is better with a complete callosotomy than with an anterior two-thirds callosotomy. However, complications are more common with complete callosal resection, including disconnection syndrome (mutism, hemiataxia, alexia).

Typically, an anterior two-thirds callosotomy is performed, with complete callosotomy reserved as a second procedure if there is inadequate relief of drop seizures after the first procedure

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