Multiple subpial transections in pediatric epilepsy: indications and outcomes

Area of Science:

• Neurosurgery
• Epileptology
• Neuroanatomy

Background:

• Multiple subpial transection (MST) is a surgical option for drug-resistant epilepsy originating in eloquent or functional brain cortex.
• Limited studies exist on the efficacy and safety of MST in pediatric and adult populations.
• This review synthesizes the scientific rationale, indications, and outcomes of MST.

Purpose of the Study:

• To review the scientific rationale, indications, and results of multiple subpial transection (MST) for epilepsy surgery.
• To evaluate the efficacy and safety of MST in managing epileptiform activity in eloquent cortical areas.

Main Methods:

• Review of neuroanatomic studies demonstrating vertical cortical organization and horizontal seizure spread.
• Analysis of studies assessing MST efficacy, often in conjunction with cortical resection or lesionectomy.
• Evaluation of complication rates and functional outcomes, including Engel classification.

Main Results:

• MST involves vertical cortical incisions to interrupt horizontal seizure propagation while preserving functional vertical columns.
• Studies indicate 33-46% of pediatric patients achieve Engel class I or II outcomes after MST.
• The procedure demonstrates a low permanent complication rate, with no reported permanent language or motor deficits.

Conclusions:

• Multiple subpial transection (MST) is a safe surgical procedure for epilepsy involving eloquent cortex.
• The specific efficacy of MST as a standalone procedure is not yet clearly defined.
• Further prospective research is required to establish the definitive role of MST in comprehensive epilepsy surgery protocols.