Multiple Subpial Transections in Eloquent Cortex for Refractory Epilepsy: 2-Dimensional Operative Video

Area of Science:

• Neurosurgery
• Epileptology
• Neurology

Background:

• Epilepsy refractory to medical therapy can be treated by resecting epileptogenic tissue.
• Resection is often not feasible in eloquent brain areas due to risk of neurological deficits.
• Palliative surgical options include deep brain stimulation, responsive neurostimulation, vagal nerve stimulation, and multiple subpial transections (MSTs).

Purpose of the Study:

• To present a case study of a patient with medically refractory epilepsy treated with MSTs.
• To demonstrate the efficacy and safety of MSTs in preserving neurological function while resecting epileptogenic tissue in eloquent brain regions.

Main Methods:

• A 34-year-old male patient with medically refractory epilepsy underwent a left-sided craniotomy.
• The seizure focus in the left pars opercularis and left superior temporal gyrus was identified using stereoelectroencephalography.
• The central seizure focus was resected, and surrounding eloquent cortex was disconnected using multiple subpial transections (MSTs).
• Hemostasis was achieved with irrigation, avoiding electrocautery.

Main Results:

• The patient remained neurologically intact postoperatively.
• The patient was discharged on postoperative day 2.
• The patient achieved seizure freedom at 11-month follow-up.

Conclusions:

• Multiple subpial transections (MSTs) are an effective surgical technique for managing epilepsy in eloquent brain areas.
• MSTs can achieve seizure control while preserving critical neurological functions.
• This case highlights the successful application of MSTs in a patient with medically refractory epilepsy.