title: Patients with refractory epilepsy treated using a modified multiple subpial transection technique.
abstract: 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%).
  
  
  CONCLUSIONS
  : This study demonstrates the efficacy and low morbidity of radiating MST performed under neuronavigation and intraoperative electrocorticography.
  
  
  BACKGROUND
  : BA, Brodmann areaEEG, electroencephalogramFDG, 18-fluorodeoxyglucoseioECoG, intraoperative electrocorticographyMRE, medically refractory epilepsyMST, multiple subpial transectionMSTa, multiple subpial transection aloneMST+, multiple subpial transection with other procedures.
authors.affiliation: Department of Neurosurgery, Center of Refractory Epilepsy, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium.
authors.forename: Glennie
authors.initials: G
authors.lastname: Ntsambi-Eba
authors.forename: Géraldo
authors.initials: G
authors.lastname: Vaz
authors.forename: Marie-Agnès
authors.initials: MA
authors.lastname: Docquier
authors.forename: Kenou
authors.initials: K
authors.lastname: van Rijckevorsel
authors.forename: Christian
authors.initials: C
authors.lastname: Raftopoulos
mesh_terms: D000293:Adolescent; D000328:Adult; D002540:Cerebral Cortex / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D004569:Electroencephalography; D004827:Epilepsy / Q000601:surgery*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D038361:Neuronavigation / Q000379:methods*; D010841:Pia Mater / Q000601:surgery; D012189:Retrospective Studies; D055815:Young Adult