Multiple Subpial Transsection MST

This technique, introduced by Morrell and Whisler, depends upon the observation that cortical organization is columnar. The functions of eloquent cortex are subserved by vertical columns, whereas the propagation of epileptic impulses occurs through horizontal fiber connections. Morrell reasoned that if multiple transsections of the cortex were made below the pia, preserving the cortical vessels, it would reduce epileptiform activity whilst preserving essential function [22].

The technique involves selective division, with specially constructed hooks under microscopic control, of the horizontal sub-pial fibres at 5-mm intervals along the gyri which exhibit epileptiform activity. It is important to maintain the integrity of the pia and avoid cortical blood vessels and also to be careful of vessels in the depths of the sulcus; the buried cortex of the insula is especially vulnerable.

Both Morrell and other authors describe using the technique both alone and in combination with resection. Published series show that the neurological consequences of MST are slight, the best results being achieved by the Chicago group. The effect on seizure control is variable; most series report reduction rather than abolition of seizures by MST alone. It is also very successful in Landau-Kleffner syndrome and has also been proposed to deal with patients with widespread multi-focal epilepsy.

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Cure Your Yeast Infection For Good

The term vaginitis is one that is applied to any inflammation or infection of the vagina, and there are many different conditions that are categorized together under this ‘broad’ heading, including bacterial vaginosis, trichomoniasis and non-infectious vaginitis.

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