This page explains about multiple subpial transection and what to expect when your child comes to Great Ormond Street Hospital (GOSH) to have this treatment.
What is a multiple subpial transection?
A multiple subpial transection is an operation that attempts to interrupt transmission of the electrical signals, which cause seizures. No area of the brain is removed as this would result in loss of functions like speech and movement. Instead, vertical cuts are made in the areas thought to be causing the seizures. This means that the transmission of seizures is reduced, but no useful functions are lost.
Why might my child need this operation?
Children who have epileptic activity that starts in areas of important brain function, like children with Landau-Kleffner Syndrome
may be considered for this procedure.
How do the doctors decide if my child needs this operation?
Your child will previously have had a series of tests and investigations to see where in the brain the seizures are starting and whether these parts of the brain are needed for important functions. When the Epilepsy Team have seen all these results, they will decide if surgery is an option. You will then be able to discuss these results with the team at an outpatient appointment at the Epilepsy Surgery Clinic and come to a decision about the operation.
What are the risks of the operation?
Healthy children usually cope well with the anaesthetic, but the risk increases if your child has other problems. Any surgery carries a small risk of infection or bleeding. In general, there is a less than one and a half per cent chance that your child will suffer some damage to his or her brain that could result in weakness down one side of the body. This will in part depend on the part of the brain involved. This will be discussed in more detail with regard to your own child. There is also a five per cent risk of complications, which may mean that your child could have to stay in hospital longer than expected.
What should I expect from this operation?
The doctors will explain the risks and benefits of the operation and the chance of improvement in seizure control to you in more detail before you make a decision. Generally, there is a 50 per cent chance that a child will experience some benefit from this operation. The chance of improvement will depend on the reasons why surgery is being performed and will be different for each child. The doctor will confirm the likelihood of success for your own child.
Are there any alternatives to this operation?
The doctors could continue trying to control your child’s seizures with combinations of drugs. However, although there are new drugs available all the time, people who have not responded to them early, have a smaller chance of responding with each new drug tried. This means that there is only a small chance of drugs controlling your child’s seizures long term.
What happens before the operation?
You will need to come to Koala Ward the day before the operation. This is to make sure that your child is well enough to have the operation.
A doctor will examine your child and take a blood sample to check that his or her blood levels are fine. The doctors will explain about the surgery in more detail, discuss any worries you may have and ask your permission for the operation, by signing a consent form. Another doctor will also visit you to explain about the anaesthetic. Occasionally, some children need neuropsychology testing and a further scan before the operation, but we will let you know if this is likely before you come into hospital.
If your child has any medical problems, for instance, allergies, please tell the doctors about these. If your child has had any infectious diseases like chicken pox or head lice recently, please tell the doctors.
The evening or the morning before the operation, your child will need to have a bath and a hair wash with a special soap.
What does the operation involve?
Your child will have this operation under a general anaesthetic. This means that your child will not feel any pain during the operation, which will last between three and four hours. Your child’s head will not be shaved completely, just a line where the doctors will make the incision. This will be done while your child is under the anaesthetic.
The doctors will make one incision on your child’s head. They will then make a series of fine cuts through the surface of the brain, while an EEG is being taken. They will have to open a piece of your child’s skull so that they can operate on the brain, but they will replace and fix it after surgery. After the operation, the doctors will close up your child’s skin and fix it with stitches.
What happens after the operation?
A member of staff will bring your child back to the ward after the operation, when he or she has recovered from the anaesthetic. When your child comes back from the operating theatre there will be no head bandage so you will be able to see where doctor made the incision. The nurses on the ward will put a head bandage on your child when he or she returns to the ward. Your child may also have a drain coming out from the wound, which looks like a clear, plastic tube. This is removed after 24 hours.
At the end of the day, the doctors will visit you to talk about the operation.
Your child may feel sick after the operation, but the doctors will give him or her medicines to reduce this. The sickness should pass within a couple of days. Children usually come back from theatre with an intravenous infusion (drip) to replace their body fluids when they are unable to drink. The nurses will monitor your child closely for the first few days after the operation to make sure he or she is recovering well.
Your child’s face may be bruised and swollen after the operation, but this is unlikely to show for a few days. This bruising and swelling will gradually reduce. If your child is in any pain, the doctors and nurses will give him or her medicines to reduce this. Your child may also develop a high temperature after the operation, but this is usual and does not tend to be due to an infection. The doctors may carry out some tests to make sure.
Over the next few days your child will be able to start moving around. All children who were able to walk before the operation will be able to walk after this time. Your child is likely to be in hospital for between three and four days. He or she will be able to gradually return to normal day-to-day life and full activity over the next two to three months. Your child should stay away from school for about six weeks after the operation. Your doctor will give you more specific information before you leave hospital.
When you and your child leave hospital, we will arrange for you to come to outpatient appointments at regular intervals. These will usually be six weeks, six months and a year after the operation. We will check that your child is recovering well from the operation and that his or her seizures are under control. It is unlikely that your child’s drugs would be changed for at least six months.
Last reviewed by Great Ormond Street Hospital: June 2009
Ref: 2009F0172 © GOSH Trust June 2009
Compiled by the Epilepsy Surgery team in collaboration with the Child and Family Information Group
This information does not constitute health or medical advice and will not necessarily reflect treatment at other hospitals. If you have any questions, please ask your doctor. No liability can be taken as a result of using this information.