Visual outcomes after anterior temporal lobectomy and transsylvian selective amygdalohippocampectomy: A quantitative comparison of clinical and diffusion data

Autor: Philip Pruckner, Karl‐Heinz Nenning, Florian Ph.S Fischmeister, Mehmet‐Salih Yildirim, Michelle Schwarz, Andreas Reitner, Susanne Aull‐Watschinger, Johannes Koren, Christoph Baumgartner, Daniela Prayer, Karl Rössler, Christian Dorfer, Thomas Czech, Ekaterina Pataraia, Gregor Kasprian, Silvia Bonelli
Rok vydání: 2023
Předmět:
Zdroj: Epilepsia. 64:705-717
ISSN: 1528-1167
0013-9580
Popis: Anterior temporal lobectomy (ATL) and transsylvian selective amygdalohippocampectomy (tsSAHE) are effective treatment strategies for intractable temporal lobe epilepsy but may cause visual field deficits (VFDs) by damaging the optic radiation (OpR). Due to the OpR's considerable variability and because it is indistinguishable from surrounding tissue without further technical guidance, it is highly vulnerable to iatrogenic injury. This imaging study uses a multimodal approach to assess visual outcomes after epilepsy surgery.We studied 62 patients who underwent ATL (n=32) or tsSAHE (n=30). Analysis of visual outcomes was conducted in four steps, including the assessment of (1) perimetry outcomes (VFD incidences/extents, n=44/40), (2) volumetric OpR-tractography-damages (n=55), and the (3) relation of volumetric OpR-tractography-damages and perimetry outcomes (n=35). Furthermore, (4) Fixel-Based-Analysis was performed to assess micro- and macrostructural changes within the OpR following surgery (n=36).Altogether, 56% of all patients had postoperative VFDs (78.9% after ATL, 36.36% after tsSAHE, p=0.011). VFDs and OpR-tractography-damages tended to be more severe within the ATL group (ATL vs. tsSAHE, integrity contralateral upper quadrant: 65% vs. 97%, p=0.002; OpR-tractography-damage: 69.2mmIn the context of controversial visual outcomes following epilepsy surgery, this study provides clinical as well as neuroimaging evidence for a higher risk and greater severity of postoperative VFDs after ATL compared to tsSAHE. Volumetric OpR-tractography-damage is a feasible parameter to reliably predict this morbidity in both treatment groups and may ultimately support personalized planning of surgical candidates. Advanced diffusion-analysis tools such as FBA offer a structural explanation of surgically induced visual pathway damage, allowing to non-invasively quantify and visualize micro- and macrostructural tract affection.
Databáze: OpenAIRE
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