Multiple Subpial Transection의 임상적 경험

Abstract

Multiple subpial transection (MST) is a new surgical technique for treating seizures arising from function ally eloquent cortex. MST could produce fiber damage that would prevent horizontal synchronization and spread of epileptic discharges while deeper vertical fibers would be unaffected, and adjacent blocks of undamaged cortex, with preserved columnar architecture, would sustain overall normal function through cortico-subcortical connections. Because the induced neurological deficits are subtle, MST can be safely performed when the epileptogenic zone involves functionally important cortex We investigated the effect of MST on both function and seizure control in 13 patients. All patients underwent chronic implantation of subdural grid and strip electrodes to identify the epileptic region and functionally eloquent cortex by using electrical stimulation. MST was applied to the motor-sensory areas in seven cases, language areas in three, and nonfunctional areas in three MST was combined with other resective surgeries in 12 patients and with corpus callosotomy in 1 patient. 1 patient had a hemiparesis, 2 patients superior quadrantanopsia with 1 patient having also Werniche’s aphasia. These neurological deficits were not considered due to MST, but combined resective surgeries or other related surgical complications. Thus, none of the 13 patients had suffered a clinically significant neurological deficit related with MST. Reduction of the seizure frequency was substantial in 10 of 13 patients who received MST, but complete seizure control was observed in 1 patient 3 of the remaining 9 patients showed 90% reduction, 2 patients 75%, 1 patient 50%, 3 patients 25% for all seizure types. In conclusion, MST may be an effective supportive approach which would minimize the excised volume and improve seizure control.