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Structural and functional effects of circumscribed temporal lobe resections

局限性颞叶切除术的结构和功能影响

基本信息

批准号：
403231417
负责人：
Dr. Niels Alexander Foit
金额：
--
依托单位：
Neuroimaging of Epilepsy Laboratory (NoEL)
依托单位国家：
德国
项目类别：
Research Fellowships
财政年份：
2018
资助国家：
德国
起止时间：
2017-12-31 至 2020-12-31
项目状态：
已结题

来源：
https://gepris.dfg.de/gepris/projekt/403231417?language=en
关键词：
Structural functional effects circumscribed temporal

项目摘要

Temporal lobe epilepsy (TLE) is the most common drug-refractory focal epilepsy. While effective in seizure control, resection of the hippocampus (HC) of the dominant temporal lobe exposes patients to a risk of postoperative verbal memory decline. In TLE with extra-hippocampal seizure onset, “hippocampus-sparing” surgery aims at preserving the largest amount of functional tissue, reducing risks of neuropsychological deterioration. Nevertheless, we recently demonstrated VM decline in TLE patients after HC-sparing resections. Furthermore, significant postoperative ipsilateral hippocampal volume loss was observed, which correlated with reduced VM performance. Since the HC is part of a distributed memory network within the temporal lobe (TL), it is conceivable that even limited TL resection could disrupt this network, ultimately leading to HC atrophy through loss of input from afferent brain regions. To evaluate effects of TL lesionectomy on brain structure and function locally and at distance, the proposed project will target cohorts of patients with anterior TL resection (N=30), HC-s lesionectomy (N=20) and healthy controls (N=30).We will perform hippocampus subfield volumetry on pre- and post-operative MRI to evaluate subfield-specific postoperative alterations. Results will be correlated with neuropsychological data (confrontation naming, verbal fluency, verbal free recall, short-term memory). Additionally, linear models will be used to relate the impact of HC-s surgery on cortical connectivity appreciated through diffusion-tensor imaging locally within the TL and at large-scale. Moreover, we will build predictive models of post-operative cognitive outcome based on structural and functional connectivity metrics.Postoperative memory decline is a serious complication in TLE surgery, with strong impact on postoperative quality of life. Better understanding of the effects of surgery on TL structural and functional networks will allow for the prediction of postoperative neuropsychological performance. In patients at high-risk for VM loss, this will ultimately aid in preoperative counseling and clinical decision making

颞叶癫痫(TLE)是最常见的药物难治性局灶性癫痫。虽然在癫痫控制方面有效，但切除占主导地位的颞叶的海马体(HC)会使患者面临术后言语记忆下降的风险。在海马区外癫痫发作的TLE患者，“保留海马体”手术的目的是保留最大数量的功能组织，降低神经心理恶化的风险。然而，我们最近发现，保留HC的TLE患者术后Vm下降。此外，观察到术后同侧海马体体积显著减少，这与Vm表现降低有关。由于HC是颞叶(TL)内分布式记忆网络的一部分，可以想象，即使有限的TL切除也可能扰乱这一网络，最终通过失去传入脑区的输入而导致HC萎缩。为了评估TL病变切除对局部和远距离脑结构和功能的影响，该计划将针对TL前切除术(N=30)、HC-S病变切除(N=20)和健康对照组(N=30)患者。我们将在术前和术后进行海马区体积测量，以评估亚区特异性的术后改变。结果将与神经心理学数据(对峙命名、言语流畅性、言语自由回忆、短期记忆)相关联。此外，线性模型将被用来联系HC-S手术对皮质连通性的影响，通过在TL内局部和大范围内的扩散张量成像来评估。此外，我们将建立基于结构和功能连接性度量的术后认知结果预测模型。术后记忆衰退是TLE手术的严重并发症，对术后生活质量有很大影响。更好地了解手术对TL结构和功能网络的影响将有助于预测术后的神经心理表现。对于VM丢失的高危患者，这最终将有助于术前咨询和临床决策。