GASTROPARESIS AFTER COMBINED CALLOSOTOMY AND UNILATERAL FRONTAL LOBECTOMY

An 8-year-old boy with medically refractory seizures received a combined anterior corpus callosotomy and extensive right frontal cortical resection. Postoperatively, the patient developed severe, persistent gastroparesis without other apparent cause. A literature review revealed no similar cases. Human and animal studies suggest that the frontal lobe influences gastric motility via the hypothalamus. This experience indicates that removal of such frontal lobe influence or combined frontal lobectomy/callosotomy may precipitate gastroparesis. Surgery involving the insular cortex, orbitofrontal area, and premotor cortex may particularly place patients at risk for this complication.