Usefulness of Diffusion Tensor Tractography in Pediatric Epilepsy Surgery.
- Author:
Mi Jung LEE
1
;
Heung Dong KIM
;
Joon Soo LEE
;
Dong Seok KIM
;
Seung Koo LEE
Author Information
- Publication Type:Original Article
- Keywords: Child; epilepsy; diffusion MRI; tractography
- MeSH: Adolescent; Adult; Brain Neoplasms/pathology/surgery; Child; Child, Preschool; Diffusion Tensor Imaging/*methods; Epilepsy/*pathology/*surgery; Female; Hippocampus/pathology; Humans; Infant; Male; Retrospective Studies; Sclerosis/pathology/surgery; Seizures/surgery; Treatment Outcome; Young Adult
- From:Yonsei Medical Journal 2013;54(1):21-27
- CountryRepublic of Korea
- Language:English
- Abstract: PURPOSE: This study was conducted to assess the clinical relevance of diffusion tensor tractography (DTT) in pre- and post-operative evaluations of childhood epilepsy surgery. MATERIALS AND METHODS: Seventy-two patients who received epilepsy surgery between March 2004 and July 2008 were retrospectively analyzed (M : F=40 : 32, ages of 3 months to 24 years, mean age=8.9 years). DTT was performed using a 3.0 T scanner and single-shot spin-echo echo-planar imaging with 32-different diffusion gradient directions. We reviewed the data focusing on the type of surgery, final pathological diagnosis, and how the DTT data were clinically used. RESULTS: The most common form of childhood epilepsy surgery was complete resection of an epileptogenic lesion (n=52, 72.2%). The reported etiologies included cortical dysplasia (n=32, 44.4%), hippocampal sclerosis (n=9, 12.5%), brain tumors (n=7, 9.7%), and non-pathologic lesions (n=4, 5.6%) in the final diagnoses. Twenty-one dysplastic cortexes and four brain tumors involved an approximal relationship with the corticospinal tract (n=18), optic radiation (n=2), and arcuate fasciculus (n=5). Additionally, although DTT demonstrated white matter tracts clearly, DTT in the hippocampal sclerosis did not provide any additional information. In cases of callosotomy (n=18, 25%), post-operative DTT was utilized for the evaluation of complete resection in all patients. DTT information was not used in functional hemispherectomy (n=2, 2.8%). CONCLUSION: Preoperatively, DTT was a useful technique in cases of cortical dysplasia and brain tumors, and in cases with callosotomy, postoperatively. DTT should be included among the routine procedures performed in management of epilepsy.
