Multiple Subpial Transection (cont.)
What Happens Before Surgery?
Candidates for MST undergo an extensive pre-surgery evaluation - including seizure monitoring, electroencephalography (EEG), magnetic resonance imaging (MRI) and positron emission tomography (PET). These tests help to pinpoint the area in the brain where the seizures occur and determine if surgery is feasible.
Another test to assess electrical activity in the brain is EEG-video monitoring, in which video cameras are used to record seizures as they occur, while the EEG monitors the brain's activity. In some cases, invasive monitoring-in which electrodes are placed inside the skull over a specific area of the brain also is used to further identify the tissue responsible for seizures.
What Happens During Surgery?
MST requires exposing an area of the brain using a procedure called a craniotomy. (Crani refers to the skull and otomy means "to cut into.") After the patient is put to sleep, the surgeon makes an incision (cut) in the scalp, removes a piece of bone and pulls back a section of the dura, the tough membrane that covers the brain. This creates a "window" in which the surgeon inserts his or her surgical instruments. The surgeon utilizes information gathered during pre-surgical brain imaging to help identify the area of abnormal brain tissue and avoid areas of the brain responsible for vital functions.
Using a surgical microscope to produce a magnified view of the brain, the surgeon makes a series of parallel, shallow cuts (transections) in gray matter, just below the pia mater (subpial), the delicate membrane that surrounds the brain (it lies beneath the dura). The cuts are made over the entire area identified as the source of the seizures. After the transactions are made, the dura and bone are fixed back into place, and the scalp is closed using stitches or staples.
Next: What happens after multiple subpial transection surgery? »
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