Changes in fiber tract integrity and visual fields after anterior temporal lobectomy
Changes in fiber tract integrity and visual fields after anterior temporal lobectomy
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DOI：
10.1212/wnl.0b013e3181fb44db
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发表时间：
2010-11-02
期刊：
影响因子：
9.9
通讯作者：
Dale, A. M.
中科院分区：
文献类型：
--
作者：
McDonald, C. R.;Hagler, D. J., Jr.;Dale, A. M.
目的：探讨颞叶癫痫（TLE）患者前颞叶切除术（ATL）后纤维束完整性的变化，并确定术后变化是否稳定或进展，以及是否与视野缺损有关。方法：对7例TLE患者在ATL术前、术后2个月和术后1年进行弥散张量成像（DTI）。分数各向异性（FA）的变化进行了评价，在全脑体素分析，以及在特定的纤维束。重复测量方差分析进行检查同侧和对侧纤维束内FA变化的时间过程。进行定量视野分析以确定区域FA的降低是否与视野缺损的范围或位置相关。患者在手术期间横断的同侧纤维束中显示ATL后2个月FA降低（海马旁扣带、钩束、下纵束和穹窿），以及未直接横切的纤维束（额枕下束和胼胝体）。ATL后2个月至1年未观察到FA进一步降低。大部分患者的视野缺损以不完全象限盲为特征。然而，FA减少一名患者延伸到颞枕叶皮质和压部的胼胝体，并与一个完整的hemianobios.Conclusions：沃勒变性是明显的2个月后，单方面的ATL在同侧纤维直接和间接影响手术。这些变化在一年内似乎没有进展，但可能与术后视野缺损的性质和程度相关。神经病学（R）2010;75：1631-1638
Objective: To investigate postoperative changes in fiber tract integrity in patients with temporal lobe epilepsy (TLE) following anterior temporal lobectomy (ATL) and to determine whether postoperative changes are 1) stable vs progressive and 2) related to visual field defects.Methods: Diffusion tensor imaging (DTI) was obtained in 7 patients with TLE before, 2 months after, and 1 year after ATL. Changes in fractional anisotropy (FA) were evaluated in a whole-brain voxel-wise analysis, as well within specific fiber tracts. Repeated-measures analysis of variance was performed to examine the time course of FA changes within ipsilateral and contralateral fiber tracts. Quantitative visual field analysis was performed to determine whether decreases in regional FA were related to the extent or location of visual field defects.Results: Patients showed decreased FA 2 months post-ATL in ipsilateral fiber tracts transected during surgery (parahippocampal cingulum, uncinate fasciculus, inferior longitudinal fasciculus, and fornix), as well as in fiber tracts not directly transected (inferior fronto-occipital fasciculus and corpus callosum). Additional decreases in FA were not observed from 2 months to 1 year post-ATL. Visual field defects in most patients were characterized by incomplete quadrantanopsias. However, FA reductions in one patient extended into temporo-occipital cortex and the splenium of the corpus callosum and were associated with a complete hemianopia.Conclusions: Wallerian degeneration is apparent 2 months following unilateral ATLs in ipsilateral fibers directly and indirectly affected during surgery. These changes do not appear to progress over the course of a year, but may correlate with the nature and extent of postoperative visual field defects. Neurology (R) 2010;75:1631-1638