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Multiple subpial transections and magnetic resonance imaging.

P Finet1, C Grandin1, G Vaz1

  • 1Department of Neurosurgery, University hospital Saint-Luc, 10, avenue Hippocrate, 1200 Brussels, Belgium.

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Summary

Multiple subpial transection (MST) for epilepsy leaves minimal MRI-visible cortical changes. T2-weighted MRI sequences, especially later scans, best show these subtle, non-complicated lesions.

Keywords:
MRIMedically refractory epilepsyMultiple subpial transectionsRadiating

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Area of Science:

  • Neurosurgery
  • Neuroradiology
  • Epileptology

Background:

  • Multiple subpial transection (MST) is a surgical option for refractory epilepsy involving eloquent cortical areas.
  • Limited Magnetic Resonance Imaging (MRI) data exists on the cortical effects of MST.

Purpose of the Study:

  • To evaluate the post-operative cortical changes following MST using MRI.
  • To identify optimal MRI sequences for visualizing MST-induced alterations.

Main Methods:

  • Ten epilepsy patients undergoing MST were included.
  • Post-operative MRI scans (1.5T and 3.0T) were analyzed, including intraoperative, early, and late follow-ups.
  • T2 and T2* weighted sequences were prioritized for assessment.

Main Results:

  • MST-induced changes were visible in all 10 patients across various MRI time points.
  • T2-weighted sequences, particularly late MRI scans, best visualized MST stigmas.
  • Lesions appeared as micro-hemorrhagic spots (intraoperative), cortical edema (early), and micro-cavities with hemosiderin (late).

Conclusions:

  • MST results in limited, observable cortical modifications detectable by MRI.
  • T2-weighted MRI sequences are optimal for assessing MST-induced cerebral lesions, especially in late post-operative scans.