Utility of diffusion tensor imaging studies linked to neuronavigation and other modalities in repeat hemispherotomy for intractable epilepsy

OBJECT Hemispherectomy for unilateral, medically refractory epilepsy is associated with excellent long-term seizure control. However, for patients with recurrent seizures following disconnection, workup and investigation can be challenging, and surgical options may be limited. Few studies have examined the role of repeat hemispherotomy in these patients. The authors hypothesized that residual fiber connections between the hemispheres could be the underlying cause of recurrent epilepsy in these patients. Diffusion tensor imaging (DTI) was used to test this hypothesis, and to target residual connections at reoperation using neuronavigation. METHODS The authors identified 8 patients with recurrent seizures following hemispherectomy who underwent surgery between 1995 and 2012. Prolonged video electroencephalography recordings documented persistent seizures arising from the affected hemisphere. In all patients, DTI demonstrated residual white matter association fibers connecting the hemispheres. A repeat craniotomy and neuronavigation-guided targeted disconnection of these residual fibers was performed. Engel class was used to determine outcome after surgery at a minimum of 2 years of follow-up. RESULTS Two patients underwent initial hemidecortication and 6 had periinsular hemispherotomy as their first procedures at a median age of 9.7 months. Initial pathologies included hemimegalencephaly (n = 4), multilobar cortical dysplasia (n = 3), and Rasmussen's encephalitis (n = 1). The mean duration of seizure freedom for the group after the initial procedure was 32.5 months (range 6–77 months). In all patients, DTI showed limited but definite residual connections between the 2 hemispheres, primarily across the rostrum/genu of the corpus callosum. The median age at reoperation was 6.8 years (range 1.3–14 years). The average time taken for reoperation was 3 hours (range 1.8–4.3 hours), with a mean blood loss of 150 ml (range 50–250 ml). One patient required a blood transfusion. Five patients are seizure free, and the remaining 3 patients are Engel Class II, with a minimum follow-up of 24 months for the group. CONCLUSIONS Repeat hemispherotomy is an option for consideration in patients with recurrent intractable epilepsy following failed surgery for catastrophic epilepsy. In conjunction with other modalities to establish seizure onset zones, advanced MRI and DTI sequences may be of value in identifying patients with residual connectivity between the affected and unaffected hemispheres. Targeted disconnection of these residual areas of connectivity using neuronavigation may result in improved seizure outcomes, with minimal and acceptable morbidity.

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Impact of intraoperative 3-T MRI with diffusion tensor imaging on hemispherectomy

Journal of Neurosurgery Pediatrics ◽

10.3171/2016.4.peds15568 ◽

2017 ◽

Vol 19 (1) ◽

pp. 63-69 ◽

Cited By ~ 5

Author(s):

Gun-Ha Kim ◽

Joo Hee Seo ◽

Seema Schroff ◽

Po-Ching Chen ◽

Ki Hyeong Lee ◽

...

Keyword(s):

Diffusion Tensor Imaging ◽

Diffusion Tensor ◽

Outcome Data ◽

Seizure Outcome ◽

Seizure Freedom ◽

Cross Sectional ◽

Additional Surgery ◽

Class 1 ◽

Patients With Epilepsy

OBJECTIVE Hemispherectomy can produce remarkable seizure control of medically intractable hemispheric epilepsy in children, but some patients continue to have seizures after surgery. A frequent cause of treatment failure is incomplete surgical disconnection of the abnormal hemisphere. This study explores whether intraoperative 3-T MRI with diffusion tensor imaging (DTI) during hemispherectomy can identify areas of incomplete disconnection and allow complete disconnection during a single surgery. METHODS The charts of 32 patients with epilepsy who underwent hemispherectomy between January 2012 and July 2014 at the Florida Hospital for Children were reviewed. Patients were grouped as having had curative or palliative hemispherectomy. To assess the completeness of disconnection when the surgeon considered the operation completed, intraoperative 3-T MRI-DTI was performed. If incomplete disconnection was identified, additional surgery was performed until MRI-DTI sequences confirmed satisfactory disconnection. Seizure outcome data were collected via medical records at last follow-up. RESULTS Of 32 patients who underwent hemispherectomy, 23 had curative hemispherectomy and 9 had palliative hemispherectomy. In 11 of 32 surgeries, the first intraoperative MRI-DTI sequences suggested incomplete disconnection and additional surgery followed by repeat MRI-DTI was performed. Complete disconnection was accomplished in 30 of 32 patients (93.8%). Two of 32 disconnections (6.3%) were incomplete on postoperative imaging. Cross-sectional results showed that 21 of 23 patients (91.3%) who had curative hemispherectomy remained free of seizures (International League Against Epilepsy Class 1) at a median follow-up of 1.7 years (range 0.4–2.9 years). The longitudinal seizure freedom after curative hemispherectomy was 95.2% (SE 0.05) at 6 months, 90.5% (SE 0.06) at 1 year, and 90.5% (SE 0.05) at 2 years. CONCLUSIONS Intraoperative 3-T MRI-DTI sequences can identify incomplete disconnection during hemispherectomy and allow higher rates of complete disconnection in a single surgery. Higher rates of complete disconnection seem to achieve better seizure-free outcome following modified functional hemispherectomy.

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Changes in the corticospinal tract after wearing prosthesis in bilateral transtibial amputation

Prosthetics and Orthotics International ◽

10.1177/0309364616684216 ◽

2017 ◽

Vol 41 (5) ◽

pp. 507-511

Author(s):

Sang Yoon Lee ◽

Si Hyun Kang ◽

Don-Kyu Kim ◽

Kyung Mook Seo ◽

Hee Joon Ro ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Diffusion Tensor Imaging ◽

Magnetic Resonance ◽

Primary Motor Cortex ◽

Corticospinal Tract ◽

Diffusion Tensor ◽

Brain Magnetic Resonance Imaging ◽

Resonance Imaging ◽

Transtibial Amputation

Background:After amputation, the brain is known to be reorganized especially in the primary motor cortex. We report a case to show changes in the corticospinal tract in a patient with serial bilateral transtibial amputations using diffusion tensor imaging.Case Description and Methods:A 78-year-old man had a transtibial amputation on his left side in 2008 and he underwent a right transtibial amputation in 2011. An initial brain magnetic resonance imaging with a diffusion tensor imaging was performed before starting rehabilitation on his right transtibial prosthesis, and a follow-up magnetic resonance imaging with diffusion tensor imaging was performed 2 years after this.Findings and Outcomes:In the initial diffusion tensor imaging, the number of fiber lines in his right corticospinal tract was larger than that in his left corticospinal tract. At follow-up diffusion tensor imaging, there was no definite difference in the number of fiber lines between both corticospinal tracts.Conclusion:We found that side-to-side corticospinal tract differences were equalized after using bilateral prostheses.Clinical relevanceThis case report suggests that diffusion tensor imaging tractography could be a useful method to understand corticomotor reorganization after using prosthesis in transtibial amputation.

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The utility of diffusion tensor imaging tractography for post-operative evaluation of a patient with hemispherotomy performed for intractable epilepsy

Brain and Development ◽

10.1016/j.braindev.2013.08.001 ◽

2014 ◽

Vol 36 (7) ◽

pp. 641-644 ◽

Cited By ~ 3

Author(s):

Keisuke Toda ◽

Hiroshi Baba ◽

Tomonori Ono ◽

Kenji Ono

Keyword(s):

Diffusion Tensor Imaging ◽

Diffusion Tensor ◽

Intractable Epilepsy ◽

Operative Evaluation ◽

Diffusion Tensor Imaging Tractography

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The Effectiveness of Diffusion Tensor Imaging in Determining Radiological Response after Radiosurgery in Patients with Vestibular Schwannoma

Current Medical Imaging Formerly Current Medical Imaging Reviews ◽

10.2174/1573405617666210127160848 ◽

2021 ◽

Vol 17 ◽

Author(s):

Dilek Hacer Cesme ◽

Alpay Alkan ◽

Lutfullah Sari ◽

Ahmet Kaya ◽

Ismail Yurtsever ◽

...

Keyword(s):

Diffusion Tensor Imaging ◽

Vestibular Schwannoma ◽

Tumor Volume ◽

Diffusion Tensor ◽

Response To Treatment ◽

Adc Values ◽

Radiological Response ◽

Group 2 ◽

Group 1

Background: The effectiveness of Diffusion Tensor Imaging (DTI) in demonstrating functional changes in the tumor in determining the response to treatment after radiosurgery in patients with vestibular schwannoma (VS) is not clear yet. Objective: The study aimed to determine the change total in tumor volume (TTV) in terms of radiological response in patients who had VS and were treated with radiosurgery and investigate the relationship between the TTV, follow-up times and DTI parameters. Methods: Thirty-one patients were assessed using DTI and MRI. TTV, apparent diffusion coefficient (ADC), and fractional anisotropy (FA) were calculated. Patients were divided into tree groups: those who responded to the treatment (group 1) (n=11), who did not (group 0) (n=9) and who remained stable (group 2) (n=11). Background: The effectiveness of Diffusion Tensor Imaging (DTI) in demonstrating functional changes in the tumor in determining the response to treatment after radiosurgery in patients with vestibular schwannoma (VS) is not clear yet. Objective: The study aimed to determine the change total in tumor volume (TTV) in terms of radiological response in patients who had VS and were treated with radiosurgery and investigate the relationship between the TTV, follow-up times and DTI parameters. Methods: Thirty-one patients were assessed using DTI and MRI. TTV, apparent diffusion coefficient (ADC), and fractional anisotropy (FA) were calculated. Patients were divided into tree groups: those who responded to the treatment (group 1) (n=11), who did not (group 0) (n=9) and who remained stable (group 2) (n=11). Results: The mean duration of follow-up was 28.81±14 months. ADC values increased in patients with VS after radiosurgery (p=0.004). There was no statistical difference in the FA values. A significant reduction in TTV after radiosurgery was detected in group 1 (p=0.003). ADC values increased significantly after radiosurgery in group 2 (p=0.04). Although there were no significant differences, ADC values after radiosurgery increased in group 1 and group 0. Conclusions: ADC values continuously increase due to radiation damage in the period before the tumor volume shrinks after radiosurgery. We think that it is not appropriate to diagnose inadequate treatment or progression only when TTV is evaluated in terms of response to treatment in the early period after radiosurgery.

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Diffusion tensor imaging in multiple sclerosis: a tool for monitoring changes in normal-appearing white matter

Multiple Sclerosis Journal ◽

10.1191/1352458504ms997oa ◽

2004 ◽

Vol 10 (2) ◽

pp. 188-196 ◽

Cited By ~ 57

Author(s):

Emmanuelle Cassol ◽

Jean-Philippe Ranjeva ◽

Danielle Ibarrola ◽

Claude Mékies ◽

Claude Manelfe ◽

...

Keyword(s):

Multiple Sclerosis ◽

Diffusion Tensor Imaging ◽

White Matter ◽

Diffusion Tensor ◽

Lesion Load ◽

Normal Appearing White Matter ◽

Relapsing Remitting ◽

One Year ◽

Diffusion Tensor Imaging Dti

Our objectives were to determine the reproducibility of diffusion tensor imaging (DTI) in volunteers and to evaluate the ability of the method to monitor longitudinal changes occurring in the normal-appearing white matter (NAWM) of patients with multiple sclerosis (MS). DTI was performed three-mo nthly for one year in seven MS patients: three relapsing-remitting (RRMS), three secondary progressive (SPMS) and one relapsing SP. They were selected with a limited cerebral lesion load. Seven age- and sex-matched controls also underwent monthly examinations for three months. Diffusivity and anisotropy were quantified over the segmented whole supratentorial white matter, with the indices of trace (Tr) and fractional anisotropy (FA). Results obtained in volunteers show the reproducibility of the method. Patients had higher trace and lower anisotropy than matched controls (P B-0.0001). O ver the follow-up, both Tr and FA indicated a recovery after the acute phase in RRMS and a progressive shift towards abnormal values in SPMS. A lthough this result is not statistically significant, it suggests that DTI is sensitive to microscopic changes occurring in tissue of normal appearance in conventional images and could be useful for monitoring the course of the disease, even though it was unable to clearly distinguish between the various physiopathological processes involved.

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Value of diffusion-tensor imaging and fiber tractography in the diagnosis and follow-up of Marchiafava–Bignami disease

European Journal of Radiology Extra ◽

10.1016/j.ejrex.2009.09.005 ◽

2010 ◽

Vol 73 (2) ◽

pp. e41-e43

Author(s):

Sebastián Remollo ◽

Josep Puig ◽

María Aguirregomozcorta ◽

Jordi Gich ◽

Gerard Blasco ◽

...

Keyword(s):

Diffusion Tensor Imaging ◽

Diffusion Tensor ◽

Fiber Tractography

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Correlation between cognitive function and the association fibers in patients with Alzheimer’s disease using diffusion tensor imaging

Journal of Clinical Neuroscience ◽

10.1016/j.jocn.2011.12.031 ◽

2012 ◽

Vol 19 (12) ◽

pp. 1659-1663 ◽

Cited By ~ 17

Author(s):

Jing-Zhi Meng ◽

Li-Wei Guo ◽

Hong Cheng ◽

Yun-Jie Chen ◽

Lin Fang ◽

...

Keyword(s):

Alzheimer’S Disease ◽

Alzheimer's Disease ◽

Diffusion Tensor Imaging ◽

Cognitive Function ◽

Diffusion Tensor ◽

Association Fibers

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Progressive brain changes in schizophrenia: a 1-year follow-up study of diffusion tensor imaging

Acta Neuropsychiatrica ◽

10.1111/j.1601-5215.2009.00422.x ◽

2009 ◽

Vol 21 (6) ◽

pp. 301-307 ◽

Cited By ~ 5

Author(s):

Miho Ota ◽

Satoko Obu ◽

Noriko Sato ◽

Katsuyoshi Mizukami ◽

Takashi Asada

Keyword(s):

Diffusion Tensor Imaging ◽

Diffusion Tensor ◽

Three Dimensional ◽

Anterior Cingulate ◽

Volume Data ◽

Cross Sectional ◽

Schizophrenic Patients ◽

Brain Changes ◽

Magnetic Resonance Imaging Mri

Objective:Recent cross-sectional studies suggest that brain changes in schizophrenia are progressive during the course of the disorder. However, it remains unknown whether this is a global process or whether some brain areas are affected to a greater degree. The aim of this study was to examine the longitudinal brain changes in patients with chronic older schizophrenia by magnetic resonance imaging (MRI).Methods:Three-dimensional (3D) T1-weighted and diffusion tensor (DT) MRI were performed twice on each of 16 chronic older schizophrenia patients (mean age = 58.1 ± 6.7 years ) with an interval of 1 year between imaging sessions. To clarify the longitudinal morphological and white matter changes, volume data and normalised diffusion tensor imaging (DTI) metrics were compared between the first and follow-up studies using a paired t-test.Results:Focal cortical volume loss was observed in the left prefrontal lobe and anterior cingulate on volumetric study. In addition, DTI metrics changed significantly at the bilateral posterior superior temporal lobes, left insula, genu of the corpus callosum and anterior cingulate.Conclusion:There are ongoing changes in the brains of schizophrenic patients during the course of the illness. Discrepancies between volume data and DTI metrics may indicate that the pattern of progressive brain changes varies according to brain region.

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