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Multiple subpial transection: a review of 21 cases
I M Sawhney1, I J Robertson, C E Polkey
1Department of Clinical Neurophysiology, Maudsley Hospital, London UK.
Journal of Neurology, Neurosurgery, and Psychiatry
|March 1, 1995
Summary
Multiple subpial transection (MST) offers a viable surgical option for epilepsy when the seizure focus is in critical brain areas. This epilepsy surgery technique provides worthwhile seizure control without significant neurological deficits.
Area of Science:
- Neurosurgery
- Epileptology
Background:
- Multiple subpial transection (MST) is an innovative surgical procedure for epilepsy management.
- It is indicated for patients with intractable epilepsy where the epileptogenic zone is in a functionally critical cortical area, precluding complete resection.
Observation:
- The study reviewed 21 patients (ages 6-47) with medically intractable epilepsy or Landau-Kleffner syndrome who underwent MST.
- Preoperative MRI revealed focal abnormalities in 8 patients; electrophysiological examinations were performed on all.
- Histopathology indicated conditions such as Rasmussen's syndrome, cortical dysplasia, and cerebral tumors in affected patients.
Findings:
- MST was primarily performed in the precentral and postcentral regions.
- Three patients with Landau-Kleffner syndrome experienced significant speech recovery post-MST.
- Eleven of the 18 patients with intractable epilepsy showed a worthwhile reduction in seizure frequency.
Implications:
- MST provides a valuable treatment option for previously inoperable epilepsy cases.
- The procedure demonstrates potential for seizure reduction and functional improvement, notably in speech recovery.
- Importantly, MST did not result in chronic neurological deficits attributable to the procedure.