Multiple Subpial Transection (cont.)

What Happens During Multiple Subpial Transection?

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 with anesthesia, 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.

What Happens After Multiple Subpial Transection?

After MST, the patient generally stays in an intensive care unit for 24 to 48 hours and in a regular hospital room for three to four days. Most people who have MST will be able to return to their normal activities, including work or school, in six to eight weeks after surgery. Most patients will continue to take anti-seizure medication. Once seizure control is established, medications may be reduced or eliminated.

How Effective Is Multiple Subpial Transection?

MST results in satisfactory improvement in seizure control in about 70% of patients, although the procedure is still relatively new, and no long-term outcome data are available. Children with LKS or other forms of epilepsy not controlled by medication may have improved intellectual and psychosocial functioning following MST.

What Are the Side Effects of Multiple Subpial Transection?

The following side effects may occur after MST, although they generally go away on their own over several weeks:

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