脳梁離断術の歴史と手術適応(<特集>てんかん外科)  [in Japanese] Historical Review and Surgical Indication of Corpus Callosotomy for Medically Intractable Epilepsies(<SPECIAL ISSUE>Epilepsy Surgery)  [in Japanese]

脳梁離断術は発作の二次性全般化を防止する目的で1940年Van WagenenとHerrenにより報告された.しかしながらその後,全般発作に対する有効性が確認され,過去30年多くの症例に行われた.特に脱力発作,強直発作,全般性強直間代発作に有効で,複雑部分発作についてはその効果が一定していない.手術適応を含め,手術時期,離断範囲など未解決の点も多い.切除外科とは異なり,脳梁離断術はあくまで緩和手術であるため,発作消失率は低いが,術後発作軽減が得られ,ADL改善につながる.脳梁離断術の歴史,脳梁のてんかんにおける役割,発作抑制機序について考察した.

Corpus callosotomy for medically intractable epilepsies was initially performed to prevent secondarily seizure generalization through the corpus callosum in 1940, but surgical experiences indicated that this procedure was also effective for generalized epilepsies. Corpus callosotomy has been extensively used in the past 30 years. Results to date suggest that patients with secondarily generalized epilepsy with atonic, tonic, tonic-clonic seizure appear to respond well, while patients with complex partial seizures have less favorable results except for those with frontal lobe epilepsy. However, several issues remain controversial : the criteria of patient selection, the timing of the surgery, the extent of division, and the significance of postoperative EEG changes. We reviewed the developments of corpus callosotomy and its surgical indication, and discussed the seizure control mechanisms of the corpus callosum.