What is a Commissurotomy?

A commissurotomy is a procedure in which a surgeon separates components of the body which are joined by fibrous materials or bands. This term can be used to refer to a number of different procedures which are performed for several reasons. Depending on the location of the commissurotomy surgery, a surgical specialist such as a neurosurgeon or cardiothoracic surgeon may need to perform the surgery.

Working from the head down, the topmost example of a commissurotomy is a surgery to separate the two halves of the brain at the structure known as the corpus callosum. This is sometimes done to treat epilepsy. In people with severe epilepsy, seizures can sometimes be quite severe as a result of the firing of neurons from the originating hemisphere, across the corpus callosum, and into the other hemisphere. Performing a commissurotomy severs this connection and reduces the intensity of seizures.

While literally cutting the brain in half might sound a bit extreme, this treatment can be highly effective for some patients. The brain is also very adept at remapping, especially if this procedure is performed at a young age, and patients should not experience impairments as a result of the procedure if it is done properly. A number of studies have also been performed on people who have received this surgery to learn more about the brain works and what happens when the hemispheres cannot communicate with each other.

Another type of commissurotomy is performed on people with small mouths. Microstomia, as it is known, can make it difficult for people to eat and talk. A surgery can be used to widen the mouth. This is also sometimes done on people with scleroderma, as they can experience hardening at the corners of the mouth which may be painful or make it difficult to perform dental work.

Commissurotomy can also be performed on the heart. In patients with mitral valve stenosis, the leaves of the valve can be separated to relieve the narrowing and constriction so that the patient's heart will work better.

In addition to these specific surgeries, a commissurotomy can be performed more generally at any location in the body where fibrous tissues need to be separated and pulled apart. Such surgeries may need to be performed for an assortment of reasons, such as freeing up a joint so that it can move more comfortably or accessing a structure which would otherwise be difficult to reach.