Transecciones radiales múltiples para tratamiento de la epilepsia refractaria

Abstract

Objective: Multiple subpial transections (MST) represent a technical option of surgical treatment for patients with epileptogenic foci located in eloquent cortical areas. They could be performed in addition to other surgical techniques or alone. We report the clinical results of 10 patients who received as single MST surgery with a minimal follow-up of 5 years. Methods: The authors studied all patients who underwent a surgical intervention between 2007 and 2019 for refractory epilepsy. Among them,10 had radiating MST (rMST) as the only surgical treatment with a follow-up of at least 5 years. Results: At 5-year follow-up, 80% of our patients were Engel class I, 20% were Engel class II, none were Engel class III, and none were Engel class IV. At last follow-up, 6 patients (60%) were free of seizures, two (20%) had an over 75% decrease, and two (20%) 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 anti-epileptic drug modification. Two (20%) had a minor transient complication, and two patients (20%) had a minor permanent complication. Conclusions: MST performed alone gives a favorable outcome in 80% 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 refractory epilepsy with the epileptogenic foci located in eloquent areas.