Department of Neurological Surgery, University of California, San Francisco, California.
School of Medicine, University of California, San Francisco, California.
Neurosurgery. 2018 May 1;82(5):613-620. doi: 10.1093/neuros/nyx311.
Multiple subpial transections (MST) are a treatment for seizure foci in nonresectable eloquent areas.
To systematically review patient-level data regarding MST.
Studies describing patient-level data for MST procedures were extracted from the Medline and PubMed databases, yielding a synthetic cohort of 212 patients from 34 studies. Data regarding seizure outcome, patient demographics, seizure type, surgery type, and complications were extracted and analyzed.
Seizure freedom was achieved in 55.2% of patients undergoing MST combined with resection, and 23.9% of patients undergoing MST alone. Significant predictors for seizure freedom were a temporal lobe focus (odds ratio 4.9; 95% confidence interval 1.71, 14.3) and resection of portions of the focus, when feasible (odds ratio 3.88; 95% confidence interval 2.02, 7.45). Complications were frequent, with transient mono- or hemiparesis affecting 19.8% of patients, transient dysphasia 12.3%, and permanent paresis or dysphasia in 6.6% and 1.9% of patients, respectively.
MST is an effective treatment for refractory epilepsy in eloquent cortex, with greater chances of seizure freedom when portions of the focus are resected in tandem with MST. The reported rates of seizure freedom with MST are higher than those of existing neuromodulatory therapies, such as vagus nerve stimulation, deep brain stimulation, and responsive neurostimulation, though these latter therapies are supported by randomized-controlled trials, while MST is not. The reported complication rate of MST is higher than that of resection and neuromodulatory therapies. MST remains a viable option for the treatment of eloquent foci, provided a careful risk-benefit analysis is conducted.
多发性软膜下横切术（MST）是一种治疗非可切除功能区致痫灶的方法。
系统地回顾 MST 的患者水平数据。
从 Medline 和 PubMed 数据库中提取描述 MST 手术患者水平数据的研究，从 34 项研究中得出 212 名患者的综合队列。提取并分析了关于癫痫发作结局、患者人口统计学、癫痫发作类型、手术类型和并发症的数据。
MST 联合切除术后癫痫无发作的患者占 55.2%，单独 MST 术后癫痫无发作的患者占 23.9%。癫痫无发作的显著预测因素是颞叶病灶（优势比 4.9；95%置信区间 1.71，14.3）和在可行时切除病灶的部分（优势比 3.88；95%置信区间 2.02，7.45）。并发症很常见，19.8%的患者出现短暂性单肢或偏瘫，12.3%的患者出现短暂性构音障碍，6.6%和 1.9%的患者分别出现永久性瘫痪或构音障碍。
MST 是功能区难治性癫痫的有效治疗方法，当与 MST 联合切除病灶的部分时，癫痫无发作的机会更大。与现有的神经调节疗法（如迷走神经刺激、深部脑刺激和反应性神经刺激）相比，MST 的癫痫无发作率更高，但这些后者疗法有随机对照试验支持，而 MST 则没有。MST 的报告并发症发生率高于切除和神经调节疗法。在进行仔细的风险效益分析后，MST 仍然是治疗功能区病灶的可行选择。
