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Epilepsy surgery with preservation of brain function Hiroyuki Shimizu 1 1Department of Neurosurgery, Tokyo Metropolitan Neurological Hospital Keyword: 難治てんかん , 機能温存 , MST , 海馬多切術 pp.889-895
Published Date 2006/12/10
DOI https://doi.org/10.11477/mf.1431100409
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 Multiple subpial transection(MST), reported by Morrell in 1989, is an epoch-making surgical technique which first made it possible to surgically treat epilepsy with preservation of brain function even if the epileptic focus exists in the critical area such as motor or speech areas.

 In pediatric epileptic patients with intractable generalized seizures, including drop attacks, generalized tonic seizures and atypical absence, psychomotor developmental delay may occurs. Corpus callosotomy is very effective for these severe generalized seizures and prevent deterioration of psychomotor function. However, postoperative advance of cognition is unexpectedly worse when active epileptic discharges remain in the frontal lobe. To cope with this problem, extensive MST over the frontal neocortex with/without frontopolar disconnection brings significant improvement of cognition with further control of residual seizures.

 In temporal lobe epilepsy, almost 70-80% patients who underwent temporal lobectomy become seizure-free. However, in cases with left temporal focus without hippocampal atrophy on preoperative MRI, postoperative deterioration of verbal memory is inevitable. We recently developed a new surgical technique, called hippocampal transection. With this method, postoperative deterioration of verbal memory in left temporal lobe epilepsy can be avoided and a good seizure outcome compatible with temporal lobectomy is also obtained. A late onset left temporal lobe epilepsy without hippocampal atrophy will be best suitable for this new treatment.


Copyright © 2006, Igaku-Shoin Ltd. All rights reserved.

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電子版ISSN 1882-1243 印刷版ISSN 0001-8724 医学書院

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