MR Imaging of Corpus Callosotomy 677

MR findings in 13 patients who underwent corpus callosotomy for medically intractable seizures were reviewed. Preoperative MR studies were available in nine patients: five showed at least one morphological and/or MR signal abnormality including corpus callosal thinning (four cases), cerebellar atrophy (two cases), cortical atrophy (two cases), and periventricular hyperintensity on T2-weighted images (one case). Four patients had normal MR studies. Postoperative MR studies were obtained in 11 patients with subtotal callosotomy and two with total callosotomy. Of all pulse sequences, sagittal T1-weighted images best showed the surgical division, although two cases displayed a coaptation artifact, which was misleading. A surgical clip placed at the posterior extent of the callosotomy was best visualized with sagittal T1-weighted imaging. Two patients (15%) had MR findings consistent with subacute blood in the callosum, and three patients (23%) demonstrated parafalcial hyperintensity on T2-weighted images 1 week after callosotomy. Motion artifact was a significant problem with coronal imaging and T2-weighted pulse sequences in postoperative patients. Patients selected for corpus callosotomy may have a normal baseline MR or show nonspecific abnormalities. MR imaging is an effective method for evaluating callosal division, and in some cases, may demonstrate signal changes consistent with surgically related edema and/or blood.