When are multiple subpial transections (MSTs) offered?

When the zone of seizure onset can be localized to one region of the brain, removal (resection) of the area of seizure onset is the preferred intervention. However, in some cases the zone of seizure onset is also an area of important brain function. In these cases, a newer technique called multiple subpial transections (MSTs) may be offered.

In this operation, the neurosurgeon makes multiple, small incisions in the surface of the brain where the seizures arise. Most seizure activity spreads laterally across the brain, like a ripple on a pond. Thus, the multiple tiny incisions in the brain can inhibit seizure spread while preserving normal brain function.

MST experts

Multiple subpial transections may be used in conjunction with a resective procedure (removal of seizure onset zone), or used as the primary surgical treatment for seizures in selected cases. Our Pediatric Epilepsy Team at St. Louis Children’s Hospital has extensive experience with multiple subpial transections for intractable seizures in children, and has used this technique successfully in dozens of children.

Selected publications and abstracts from our faculty

  1. Behdad A, Limbrick DL, Bertrand M, Smyth MD: Epilepsy surgery in children with seizures arising from the Rolandic cortex. Epilepsia, 50(6):1450-61, 2009
  2. Behdad A, Trevathan E, Limbrick DD, Smyth MD: Outcome analysis of peri-Rolandic epilepsy surgery in children: Platform presentation, the AANS/CNS Joint Pediatric Section, Miami, FL 2007.
  3. Titus JB, Smyth MD, Kanive R, Blackburn LB. Nonlesional extratemporal lobe epilepsy: Neurocognitive outcomes in children after surgery. Poster presentation, American Epilepsy Society, 2007.

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