Department of Neurosurgery, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium.
Department of Neurology, Center for Refractory Epilepsy, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium.
World Neurosurg. 2019 Jun;126:e1155-e1159. doi: 10.1016/j.wneu.2019.02.218. Epub 2019 Mar 14.
Multiple subpial transection (MST) is a possible surgical treatment for patients with epileptogenic foci located in eloquent cortical areas. Commonly, it is performed in addition to other surgical techniques. In some cases, however, it is performed alone. We report the clinical results of 12 patients who received solely radiating MST with a minimal follow-up of 5 years.
All patients who underwent a surgical intervention between 2003 and 2012 for refractory epilepsy were studied. Among them, 12 had radiating MST (rMST) as the only surgical treatment with a follow-up of at least 5 years.
At 5-year follow-up, 50% of the patients were Engel class I, 25% were Engel class II, 0% were Engel class III, and 25% were Engel class IV. At last follow-up, 8 patients (67%) were free of seizures, 1 patient (8%) had an over 75% decrease, and 3 patients (25%) did not improve after the procedure. None of the Engel I patients had seizure recurrence, and those belonging to an intermediate class improved during follow-up, in some cases in association with an antiepileptic drug modification. Two patients (17%) had a minor transient complication, and 1 patient (8%) had a minor permanent complication.
rMST performed alone gives a favorable outcome in 75% of the patients at a minimum 5-year follow-up with few minor complications. This procedure appears to be effective even with a prolonged follow-up in drug resistant epilepsy with the epileptogenic foci located in eloquent areas.
多软膜下横切术（MST）是一种可能的针对位于功能区皮质的致痫灶的手术治疗方法。通常，它是在其他手术技术的基础上进行的。然而，在某些情况下，它是单独进行的。我们报告了 12 例接受放射状 MST 治疗且随访至少 5 年的患者的临床结果。
研究了 2003 年至 2012 年间因难治性癫痫接受手术干预的所有患者。其中，12 例患者接受放射状 MST（rMST）作为唯一的手术治疗，随访时间至少 5 年。
在 5 年随访时，50%的患者为 Engel Ⅰ级，25%为 Engel Ⅱ级，0%为 Engel Ⅲ级，25%为 Engel Ⅳ级。末次随访时，8 例（67%）患者无癫痫发作，1 例（8%）患者癫痫发作减少超过 75%，3 例（25%）患者术后无改善。无 1 例 Engel Ⅰ级患者癫痫复发，而处于中间级别的患者在随访期间得到改善，在某些情况下与抗癫痫药物调整有关。2 例（17%）患者出现轻微短暂性并发症，1 例（8%）患者出现轻微永久性并发症。
rMST 单独进行，在至少 5 年的随访中，75%的患者有良好的结果，少数有轻微并发症。即使在有耐药性癫痫和位于功能区的致痫灶的情况下进行长时间随访，该手术也似乎是有效的。
