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Usefulness of Diffusion Tensor Tractography in Pediatric Epilepsy Surgery

 Mi-Jung Lee  ;  Heung Dong Kim  ;  Joon Soo Lee  ;  Dong-Seok Kim  ;  Seung-Koo Lee 
 YONSEI MEDICAL JOURNAL, Vol.54(1) : 21-27, 2013 
Journal Title
Issue Date
Adolescent ; Adult ; Brain Neoplasms/pathology ; Brain Neoplasms/surgery ; Child ; Child, Preschool ; Diffusion Tensor Imaging/methods* ; Epilepsy/pathology* ; Epilepsy/surgery* ; Female ; Hippocampus/pathology ; Humans ; Infant ; Male ; Retrospective Studies ; Sclerosis/pathology ; Sclerosis/surgery ; Seizures/surgery ; Treatment Outcome ; Young Adult
Child ; epilepsy ; diffusion MRI ; tractography
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.
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1. College of Medicine (의과대학) > Dept. of Neurosurgery (신경외과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Pediatrics (소아청소년과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers
Yonsei Authors
Kim, Dong Seok(김동석)
Kim, Heung Dong(김흥동) ORCID logo https://orcid.org/0000-0002-8031-7336
Lee, Mi-Jung(이미정) ORCID logo https://orcid.org/0000-0003-3244-9171
Lee, Seung Koo(이승구) ORCID logo https://orcid.org/0000-0001-5646-4072
Lee, Joon Soo(이준수) ORCID logo https://orcid.org/0000-0001-9036-9343
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