Multiple subpial transections: the Yale experience.
OBJECTIVE
Although resection of an epileptogenic region is the mainstay of epilepsy surgery, epileptogenic areas in functionally critical cortex cannot be approached in that manner. Multiple subpial transection (MST) was developed to treat those refractory seizures without causing unacceptable neurologic deficit. We review our experience with this technique.


METHODS
Twelve patients who underwent MST with or without resection between 1990 and 1998 were retrospectively reviewed with regard to seizure and neurologic outcome, and predictive factors.


RESULTS
Five (42%) of 12 patients obtained a significant improvement in seizure frequency, and two other patients had a marked decrease in the severity of their seizures. Resection with MST reduced seizure frequency more, but this was not a significant difference. No predictive factors for outcome were identified. Only one patient sustained any persistent neurologic deficit.


CONCLUSIONS
In selected patients, MST may be a viable alternative when the epileptogenic focus lies in unresectable cortex. A multicenter study with appreciable patient numbers will be necessary to define predictive factors for success.
Department of Neurosurgery, Yale University School of Medicine, New Haven, CT 06520, U.S.A.
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D000293:Adolescent; D000328:Adult; D002540:Cerebral Cortex / Q000503:physiopathology / Q000601:surgery*; D002648:Child; D004569:Electroencephalography / Q000706:statistics & numerical data; D004827:Epilepsy / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009044:Motor Cortex / Q000503:physiopathology / Q000601:surgery; D019635:Neurosurgical Procedures / Q000379:methods; D010841:Pia Mater; D012086:Reoperation; D012189:Retrospective Studies; D014055:Tomography, Emission-Computed / Q000706:statistics & numerical data; D016896:Treatment Outcome