Remote effects of temporal lobe epilepsy surgery: long-term morphological changes after surgical resection
Remote effects of temporal lobe epilepsy surgery: long-term morphological changes after surgical resection
ABSTRACT ObjectiveWe present a semi-automated method for quantifying structural changes after epilepsy surgery that accounts for tissue deformation caused by resection. We demonstrate its utility by comparing the remote structural effects of two surgical approaches, the anterior temporal lobectomy (ATL) and the selective amygdalohippocampectomy (SAH). MethodsWe studied 37 temporal lobe epilepsy (TLE) patients who underwent resective surgery. Patients were treated with either an anterior temporal lobectomy (ATL, N=21) or a selective amygdalohippocampectomy (SAH, N=16). All patients received same-scanner MR imaging preoperatively and postoperatively (5+ months after surgery). To analyze structural changes in remote brain regions, we (1) implemented an automated method for segmenting resections with manual review, (2) applied cost function masking to the resection zone, and (3) estimated longitudinal cortical thickness changes using Advanced Normalization Tools (ANTs). We then compared post-operative changes in cortical thickness between the two surgical groups in brain regions outside the resected area. ResultsPatients treated with ATL exhibited significantly greater cortical thinning globally when compared to patients treated with SAH (p = 0.049). There were significant focal differences between the two treatment groups in the ipsilateral frontal lobe (superior medial and medial orbital regions) and insula (p > 0.001, α = 0.05 Bonferroni corrected). No significant effects were seen in the contralateral hemisphere. SignificanceWe present and share a semi-automated pipeline for quantifying remote longitudinal changes in cortical thickness after neurosurgery. The technique is applicable to a broad array of applications, including surgical planning and mapping neuropsychological function to brain structure. Using this tool, we demonstrate that patients treated with SAH for refractory temporal lobe epilepsy have less postoperative cortical thinning in remote brain regions than those treated with ATL. We share all algorithm code and results to accelerate collaboration and clinical translation of our work. KEY POINTS BOXDifferent epilepsy surgical approaches lead to distinct patterns of postoperative cortical atrophy in remote brain regionsPatients treated with SAH have less postoperative cortical thinning than patients treated with ATLThe insula and frontal lobe demonstrated the greatest focal differences in postoperative cortical thinning when comparing SAH and ATLPostoperative cortical thinning analyses may inform surgical planning and our understanding of cognitive sequelae
Davis Kathryn A.、Bernabei John M.、Revell Andrew Y.、Stein Joel M.、Litt Brian、Arnold T. Campbell、Kini Lohith G.、Das Sandhitsu R.、Morgan Victoria L.、Englot Dario J.、Lucas Tim H.
Center for Neuroengineering and Therapeutics, University of Pennsylvania||Department of Neurology, Perelman School of Medicine, University of PennsylvaniaDepartment of Bioengineering, School of Engineering & Applied Science, University of Pennsylvania||Center for Neuroengineering and Therapeutics, University of PennsylvaniaCenter for Neuroengineering and Therapeutics, University of Pennsylvania||Department of Neuroscience, School of Engineering & Applied Science, University of PennsylvaniaDepartment of Radiology, Perelman School of Medicine, University of PennsylvaniaDepartment of Bioengineering, School of Engineering & Applied Science, University of Pennsylvania||Center for Neuroengineering and Therapeutics, University of Pennsylvania||Department of Neurology, Perelman School of Medicine, University of PennsylvaniaDepartment of Bioengineering, School of Engineering & Applied Science, University of Pennsylvania||Center for Neuroengineering and Therapeutics, University of PennsylvaniaDepartment of Bioengineering, School of Engineering & Applied Science, University of Pennsylvania||Center for Neuroengineering and Therapeutics, University of PennsylvaniaDepartment of Neurology, Perelman School of Medicine, University of PennsylvaniaDepartment of Neurological Surgery, Vanderbilt University Medical Center||Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center||Institute of Imaging Science, Vanderbilt University Medical CenterDepartment of Neurological Surgery, Vanderbilt University Medical Center||Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center||Institute of Imaging Science, Vanderbilt University Medical CenterCenter for Neuroengineering and Therapeutics, University of Pennsylvania||Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania
神经病学、精神病学医学研究方法基础医学
Cortical thicknesscortical thinningatrophyvirtual resectionseizureneurosurgery
Davis Kathryn A.,Bernabei John M.,Revell Andrew Y.,Stein Joel M.,Litt Brian,Arnold T. Campbell,Kini Lohith G.,Das Sandhitsu R.,Morgan Victoria L.,Englot Dario J.,Lucas Tim H..Remote effects of temporal lobe epilepsy surgery: long-term morphological changes after surgical resection[EB/OL].(2025-03-28)[2025-05-01].https://www.medrxiv.org/content/10.1101/2020.11.05.20224873.点此复制
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