Transectional surgery may involve cutting tissue, nerves or entire organs. The process generally requires cutting across or along the length of some portion of the body, encompassing a wide range of medical procedures. Examples of operations using the transection technique include epilepsy and migraine treatments, contraceptive surgery, and organ transplantation.
Multiple subpial transection, or MST, involves severing nerve fibers that are responsible for seizure activity in the outer regions of the brain. Neurosurgeons perform this invasive procedure on patients who cannot achieve adequate seizure control through medication. Before acceptance as a candidate for the surgery, patients undergo extensive evaluation and testing. Physicians generally require seizure monitoring, electroencephalographs, and imaging studies. The information obtained from the tests allows the exact location of the origin of the seizure to be determined.
With the patient under general anesthesia, the neurosurgeon creates a skin flap and removes a section of the skull over the area of the brain where the seizure activity originates. After passing through the dura and the pia mater, the surgeon makes small, shallow, parallel cuts into the gray matter. The transection process is repeated until the entire affected area has been treated. Upon completion, the surgeon replaces the pia mater and dura, followed by the bone section. The skin flap is then stapled or sutured into place.
Following this type of transection, patients generally remain hospitalized for up to a week. Individuals usually remain on seizure medications and resume normal activities after six to eight weeks. Patients may experience headaches, fatigue, or nausea. When the disorder occurs in the speech center of the brain, they may have difficulty speaking or choosing words effectively.
Sometimes patients do not respond to medications for the treatment of migraine headaches. Another type of transection involves intracranial surgery that minimizes or eliminates temporal migraine symptoms. Pain often occurs because local muscles compress and pinch delicate nerves. Surgeons access the zygomaticotemporal nerve branch of the trigeminal nerve, located in the temple. This small nerve branch is then transected or cut through, eliminating pain transmission.
Some of the most common transections involve permanent contraceptive procedures. Women often elect to have surgeons cut, cauterize, or bind fallopian tubes, inhibiting ova advancement and sperm entrance. Male contraception generally involves transecting the vasa deferentia, preventing sperm from entering the ejaculate.
Successful tumor removal may require transection of internal organs. Malignancies encompassing the entire circumference of a colon, for example, may require total removal of sections of the organ. Surgeons may transect the colon on either side of the affected area then join the non-diseased portions together.
Liver transplants only require a segment of the organ to replace a diseased organ. Matching living donors generally undergo liver transection, in which a portion of the organ is removed. In a matter of weeks following surgery, the liver of both the donor and the recipient regenerate to normal size.
