Multiple Subpial Transection (MST) for the Control of Seizures That Originated in Unresectable Cortical Foci

Shimizu, Hiroyuki; Suzuki, I; Ishijima, Buichi; Karasawa, Shinji; Sakuma, Tadashi

doi:10.1111/j.1440-1819.1991.tb02486.x

Cited by 14 publications

(17 citation statements)

References 2 publications

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“…The success of MST, as judged by functional outcome, has also been well documented in previous publications from our center and others (1,14,18,(25)(26)(27)(28)(29)(30)(31)(32). These studies have shown that MST does not significantly interfere with the function of the transected area.…”

Section: Multiple Subpial Transectionsupporting

confidence: 78%

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Multiple Subpial Transection in Patients with Extratemporal Epilepsy

Smith

1998

Epilepsia

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Summary: Multiple subpial transection (MST) was developed to permit the treatment of partial epilepsies that reside in or encroach on eloquent cortex (language and sensorimotor cortex). It was conceived after the discoveries of the columnar organization of neocortex and that expression and spread of seizures utilize the transverse fiber network. Although the technique is simple in principle, it takes a skilled and practiced hand to avoid damage to the neocortical columns and vascular supply. The efficacy in controlling seizures with MST in extratemporal epilepsy is similar to that of resective surgery. Activities of daily living are not adversely impacted by MST. MST is a viable alternative to resection in extratemporal epilepsy. Key Words: Epilepsy-Seizures-Resection-Multiple subpial transection.Multiple subpial transection (MST) is a novel surgical technique that was designed for use in patients in whom the epileptic zone resides or encroaches on eloquent cortex (1). By eloquent cortex, we mean the primary sensorimotor cortex and the language cortex. MST is designed to transect horizontal nerve fibers while preserving the intrinsic columnar organization of the brain. This interrupts the synchronization of epileptic neurons while sparing input, output, and the vascular supply.We have performed over 100 cases of MST. Most of these cases were in combination with resection. We report the efficacy and morbidity of 100 cases of MST followed for a minimum of 2 years and a subset of 32 cases of pure transection in extratemporal surgery. BACKGROUND

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Section: Multiple Subpial Transectionsupporting

confidence: 78%

“…and others (1,14,(25)(26)(27)(28)(29)(30). An important point in evaluating efficacy of MST is whether it was performed alone or in conjunction with cortical resection.…”

Section: Multiple Subpial Transectionmentioning

confidence: 99%

Multiple Subpial Transection in Patients with Extratemporal Epilepsy

Smith

1998

Epilepsia

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“…[1][2][3][4][5][6][7][8] Most of the cortical interneurons in the sensorimotor cortex relay information in a vertical cascade synapsing with apical dendrites of pyramidal cells. Further experiments in cats have shown that surgical cross hatching of the visual cortex or implantation of mica plates did not impair visual perception.9 10 These findings confirm that most of the cortical connections responsible for cerebral function lie in the vertical columns.…”

Section: Discussionmentioning

confidence: 99%

Multiple subpial transection: a review of 21 cases.

Sawhney

Robertson

Polkey

et al. 1995

Journal of Neurology, Neurosurgery & Psychiatry

122

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Multiple subpial transection (MST) is a novel technique in surgery for epilepsy, employed in patients where some or all of the epileptogenic zone cannot be resected because it lies in a vital cortical area. Twenty one patients subjected to MST were reviewed. Eighteen patients had medically intractable epilepsy and three patients had Landau-Kleffner syndrome. Their ages ranged from 6 to 47 (mean 15.9) and duration of epilepsy ranged from 033 to 42 (mean 8.6) years. Preoperative MRI showed focal abnormalities in eight cases. Detailed electrophysiological examination was carried out on all patients. Brain resection was performed in addition to MST in 12 patients. A further six patients underwent brain biopsy. Three patients with Landau-Kleffner syndrome were subjected neither to resection nor to biopsy. Histopathological examination showed Rasmussen's syndrome in six patients, cortical dysplasia in six, cerebral tumour in one, and non-specific changes in five. Multiple subpial transection was carried out mainly in precentral and postcentral regions. Eighteen patients have been followed up for one to five years, and three for 10 months. The three patients with LandauKleffner syndrome were mute before operation and have shown substantial recovery of speech. Of the other 18, 11 showed a worthwhile decrease in seizure frequency. None of the patients developed chronic neurological deficits attributable to MST. It is concluded that MST leads to worthwhile seizure control without major neurological deficit in patients who would otherwise be inoperable. (J Neurol Neurosurg Psychiatry 1995;58:344-349)

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“…The approach was conceived and advocated for the specific situation in which resective surgery was precluded by the likelihood of neurologic compromise, and was later adapted for the treatment of some specific syndromes (2,3). Subsequently MST has been slowly (and somewhat randomly) adopted at many centers around the world, some of which have published experience with specific patient selection, seizure outcome, and neurologic status (4)(5)(6)(7)(8)(9)(10)(11)(12)(13).…”

Section: Discussionmentioning

confidence: 99%

Multiple Subpial Transection for Intractable Partial Epilepsy: An International Meta‐analysis

Spencer¹,

Schramm²,

Wyler

et al. 2002

Epilepsia

167

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Summary:Purpose: Because the number and variety of patients at any single facility is not sufficient for clinical or statistical analysis, data from six major epilepsy centers that performed multiple subpial transections (MSTs) for medically intractable epilepsy were collected.Methods: A meta-analysis was performed to elucidate the indications and outcome, and to assess the results of the procedure. Overall, 211 patients were represented with data regarding preoperative evaluation, procedures, seizure types and frequencies before and after surgery, postoperative deficits, and demographic information. Fifty-three patients underwent MST without resection.Results: In patients with MST plus resection, excellent outcome (>95% reduction in seizure frequency) was obtained in 87% of patients for generalized seizures, 68% for complex partial seizures, and 68% for simple partial seizures. For the patients who underwent MST without resection, the rate of excellent outcome was only slightly lower, at 71% for generalized, 62% for complex partial, and 63% for simple partial seizures. EEG localization, age at epilepsy onset, duration of epilepsy, and location of MST were not significant predictors of outcome for any kinds of seizures after MST, with or without resection. New neurologic deficits were found in 47 patients overall, comparable in MST with resection (23%) or without (19%).Conclusions: These preliminary results suggest that MST has efficacy by itself, with minimal neurologic compromise, in cases in which resective surgery cannot be used to treat uncontrolled epilepsy. MST should be investigated as a stand-alone procedure to allow further development of criteria and predictive factors for outcome. Key Words: Epilepsy surgeryMultiple subpial transection-MST-Refractory epilepsy.Based on anatomic and functional considerations, and on physiological observations in animal models, Morrell et al. (1) introduced the procedure of multiple subpial transections (MSTs) for the treatment of medically uncontrolled epilepsy. The approach was conceived and advocated for the specific situation in which resective surgery was precluded by the likelihood of neurologic compromise, and was later adapted for the treatment of some specific syndromes (2,3). Subsequently MST has been slowly (and somewhat randomly) adopted at many centers around the world, some of which have published experience with specific patient selection, seizure outcome, and neurologic status (4-13).A confounding aspect of such reports is the tendency to combine MST with some cortical resection, such that the efficacy and the neurologic compromise associated with either component of the approach cannot easily be separately assessed. The variable nature and distribution of underlying substrate, coupled with small numbers of patients at any one center, limit valid multivariable analyses of factors predictive of response, or even a consideration of differential efficacy. Whether MST provides substantial reduction in a specific seizure type, whether this benefit is achieved...

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Multiple Subpial Transection (MST) for the Control of Seizures That Originated in Unresectable Cortical Foci

Abstract: Multiple subpial transection (MST) was applied to 12 cases with intractable epilepsy, the foci of which were located in unresectable essential areas. The result proved that MST is effective in controlling seizures, and no explicit neurological deficits have incurred postoperatively.

Cited by 14 publications

References 2 publications

Multiple Subpial Transection in Patients with Extratemporal Epilepsy

Multiple Subpial Transection in Patients with Extratemporal Epilepsy

Multiple subpial transection: a review of 21 cases.

Multiple Subpial Transection for Intractable Partial Epilepsy: An International Meta‐analysis

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