Multiple subpial transection: A clinical assessment

Abstract

Multiple subpial transection is a surgical technique applied both in the laboratory and in the operating theater, whereby a number of thin cuts are made through the depth of the cortical ribbon to produce a disconnection of the horizontal fibers. It was proposed by Frank Morrell, who had a long and distinguished career investigating experimental models of both epilepsy and behavior in the laboratory and was an astute and careful neurologist with a special interest in epilepsy. Because of this interest in the electrophysiological and molecular mechanisms of epilepsy, in both the experimental situation and the clinical setting, it was inevitable that Frank Morrell should become involved in surgical strategies for the treatment of drug-resistant epilepsy. Any physician or surgeon, who spends time in assessing patients with chronic epilepsy for surgery, and following their treatment, will be fascinated by the interactions of brain pathology, maturation, and pathophysiology. They will also realize that although procedures can be divided into resective and functional operations, the mechanisms by which they exert their effects are a mixture of structural changes and physiological changes. Once one retreats from the “simple” cases, it may be necessary to use a variety of techniques for treating one particular patient either in combination or sequentially and in considering the application of multiple subpial transection, these strategies will have to be borne in mind.