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Purpose: This study was conducted to evaluate the efficacy and safety of anterior corpus callosotomy with a keyhole approach on refractory seizures and to evaluate this procedure for drop attacks (DAs) and generalized tonic-clonic seizures (GTCSs)., Methods: All refractory seizure patients underwent anterior corpus callosotomy (n=31) without other epilepsy surgery. Seizure response and procedure complications were evaluated., Results: Seizure types included GTCS (n=26), and atonic or tonic seizures with DA (n=9). In GTCS patients, 84.6% had >or=50% decrease in seizure frequency, and 61.5% had >or=80% reduction. In DA patients, 77.8% had >or=50% decrease in seizure frequency, and 55.6% had >or=80% reduction. There were no statistically significant differences between the groups in final efficacy. Overall complication rate for corpus callosotomy was 12.9%, the permanent complication rate was 3.2%., Conclusions: Anterior corpus callosotomy with a keyhole approach produces highly favorable outcomes for both GTCS and atonic or tonic seizures with a low risk for complications.