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Patients With Refractory Epilepsy Treated Using a Modified Multiple Subpial Transection Technique

Ntsambi-Eba, Glennie MD*; Vaz, Géraldo MD*; Docquier, Marie-Agnès MD, PhD; van Rijckevorsel, Kenou MD§; Raftopoulos, Christian MD, PhD*

doi: 10.1227/NEU.0b013e31828ba750
Research-Human-Clinical Studies

BACKGROUND: Multiple subpial transection (MST) is a potential surgical treatment for patients with epileptogenic foci located in cortical areas with higher functions. As neurosurgical teams have become more experienced with MST, the original technique has adapted.

OBJECTIVE: To report our 6-year experience with a modified MST technique.

METHODS: The population included 62 consecutive patients with medically refractory epilepsy treated by MST, with a follow-up period ranging from 2 to 9 years. MST was performed on gyri under neuronavigation and guided by intraoperative electrocorticography. We performed radiating MST from a single cortical entry point. The MST technique was described according to the number of transections performed and the Brodmann areas (BAs) involved. Any MST-related complications were registered and followed up. Clinical outcome was described in terms of seizure suppression or reduction according to the Engel modified classification.

RESULTS: Twelve patients underwent MST alone (MSTa), and 50 had MST with another procedure. The main MST sites were BA 4 (61%) and 3, 1, 2 (58%); in 22% of cases, MST was performed in BA 44, 22, 39, and 40. Permanent neurological deficits were observed in 4 (6.4%) patients; 2 minor deficits were MST related (3.2%). A reduction in the seizure rate of at least 50% was seen in 79% of patients (MSTa group, 75%), and 42% became seizure free (MSTa group, 33%).

CONCLUSION: This study demonstrates the efficacy and low morbidity of radiating MST performed under neuronavigation and intraoperative electrocorticography.

ABBREVIATIONS: BA, Brodmann area

EEG, electroencephalogram

FDG, 18-fluorodeoxyglucose

ioECoG, intraoperative electrocorticography

MRE, medically refractory epilepsy

MST, multiple subpial transection

MSTa, multiple subpial transection alone

MST+, multiple subpial transection with other procedures

*Department of Neurosurgery, Center of Refractory Epilepsy, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium;

Department of Anesthesiology, Center of Refractory Epilepsy, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium;

§Department of Neurology, Center of Refractory Epilepsy, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium

Correspondence: Christian Raftopoulos, MD, PhD, Department of Neurosurgery, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Avenue Hippocrate, 10, Brussels 1200, Belgium. E-mail: christian.raftopoulos@uclouvain.be

Received May 29, 2012

Accepted January 29, 2013

Copyright © by the Congress of Neurological Surgeons