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The evolving utility of diffusion tensor tractography in the surgical management of temporal lobe epilepsy: a review

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Abstract

Background

Diffusion tensor imaging (DTI) is a relatively new imaging modality that has found many peri-operative applications in neurosurgery.

Methods

A comprehensive survey of the applications of diffusion tensor imaging (DTI) in planning for temporal lobe epilepsy surgery was conducted. The presentation of this literature is supplemented by a case illustration.

Results

The authors have found that DTI is well utilized in epilepsy surgery, primarily in the tractography of Meyer’s loop. DTI has also been used to demonstrate extratemporal connections that may be responsible for surgical failure as well as perioperative planning. The tractographic anatomy of the temporal lobe is discussed and presented with original DTI pictures.

Conclusions

The uses of DTI in epilepsy surgery are varied and rapidly evolving. A discussion of the technology, its limitations, and its applications is well warranted and presented in this article.

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Author information

Authors and Affiliations

  1. Department of Neurosurgery and Brain Repair, University of South Florida, Morsani College of Medicine, 2 Tampa General Circle, 7th Floor, Tampa, FL, 33606, USA

    Sananthan Sivakanthan, Elliot Neal & Fernando L. Vale

  2. Brainlab Inc, Westchester, IL, USA

    Elliot Neal

  3. Department of Radiology, University of South Florida, Morsani College of Medicine, Tampa, FL, USA

    Ryan Murtagh

Authors
  1. Sananthan Sivakanthan
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  2. Elliot Neal
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  3. Ryan Murtagh
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  4. Fernando L. Vale
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Corresponding author

Correspondence to Sananthan Sivakanthan.

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Funding

No funding was received for this research.

Conflicts of interest

Author Mr. Elliot Neal is an employee of Brainlab Inc. The other authors have nothing to disclose.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Comments

Surgery for temporal lobe epilepsy is often promising for seizure control. However, a variety of different neurological and neuropsychological side effects have to be considered sequences of surgery within the temporal lobe. Most of these unwanted side effects are either definitely or potentially triggered by injury to white-matter tracts, more than by cortical damage. This holds true for visual field defects, but probably also for short-term memory and speech problems or psychiatric sequels. Thus, better and individual control of white-matter tracts and the transfer of this knowledge to surgical strategies are important. One has to be aware that fiber tracking with diffusion tensor imaging is not equal to visualization of nerve fibers, per se. However, fiber tracking may provide important preoperative hints for surgical planning. We have tried to reduce the rate of postoperative visual field defects by a strictly basal approach for hippocampal resection, based on findings from DTI - tractography. Further positive effects have been inconsistently suggested. Application of DTI may support the notion of white-matter changes and their avoidance in temporal lobe surgery. Thus, this review provides an overview of what has been reached so far with temporal tractography, and warrants more experience with its future application and related benefits for patients.

Hans Clusmann

Aachen, Germany

Electronic supplementary material

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Three dimensional tractography anatomy of the temporal lobe. Supplemental video is original. (MP4 30290 kb)

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Sivakanthan, S., Neal, E., Murtagh, R. et al. The evolving utility of diffusion tensor tractography in the surgical management of temporal lobe epilepsy: a review. Acta Neurochir 158, 2185–2193 (2016). https://doi.org/10.1007/s00701-016-2910-5

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  • DOI: https://doi.org/10.1007/s00701-016-2910-5

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