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Updated: Aug 15, 2026
Anteromesial Temporal Lobectomy for Medically Intractable Temporal Lobe Epilepsy: An Operative Study
Published on: August 15, 2025
Reliable registration of preoperative MRI with histopathology after temporal lobe resections
Sofia H Eriksson1, Samantha L Free, Maria Thom
1Department of Clinical and Experimental Epilepsy, National Society for Epilepsy, United Kingdom. s.eriksson@ion.ucl.ac.uk
Purpose:
Conventional and novel magnetic resonance imaging (MRI) techniques can detect cerebral abnormalities in patients with refractory focal epilepsies. Correlation of preoperative MRI and histopathology is important to validate MRI findings, but in practice is far from straightforward. Peroperative neuronavigation and placement of markers on tissue is of limited use in temporal lobe resections. MRI scanning of the resected specimen for registration with in vivo MRI is complicated by anisotropic tissue deformation. We have developed a method to facilitate registration of preoperative MRI with the resected specimen and to enable correlation of MRI findings with histopathology.
Methods:
Sixteen en bloc temporal lobe resections undertaken for refractory temporal lobe epilepsy were studied. The specimens were fixed in formalin and then cut coronally by using a cradle with parallel blades at 5-mm intervals to ensure evenly thick tissue slices in the same orientation. Volumetric T1-weighted preoperative MRIs were reformatted, and consecutive slices (0.94 mm) cut in the same orientation as the resected lobe were visually compared with photographs of tissue slices by two independent observers.
Results:
In 15 (94%) of 16 cases, a <2-mm difference was found between the two observers' matches of MRI slices with tissue slices. In the last case, a 4-mm difference was noted. In all cases, a consensus was reached by the two observers. The suggested MRI-histology matches were within the resections seen on postoperative scans.
Conclusions:
Careful labelling and postoperative handling and slicing ensured histopathologic tissue slices of uniform thickness and slicing angle. This technique can be applied to a range of MRI datasets, enabling exploration of the pathologic basis of abnormalities on conventional and novel MRI acquisitions.
Insights
A new method accurately registers preoperative magnetic resonance imaging (MRI) with resected epilepsy tissue. This improves correlation of MRI findings with histopathology for better understanding of cerebral abnormalities.
Area of Science:
- Neurology
- Radiology
- Pathology
Background:
- Refractory focal epilepsies often involve cerebral abnormalities detectable by magnetic resonance imaging (MRI).
- Correlating preoperative MRI with histopathology is crucial for validating findings but challenging due to tissue deformation.
- Current methods like neuronavigation have limitations in temporal lobe resections.
Purpose of the Study:
- To develop and validate a method for accurate registration of preoperative MRI with resected temporal lobe specimens.
- To facilitate the correlation of MRI-detected abnormalities with histopathology in epilepsy surgery.
- To overcome challenges posed by anisotropic tissue deformation during specimen processing.
Main Methods:
- Studied 16 en bloc temporal lobe resections for refractory temporal lobe epilepsy.
- Fixed specimens and cut uniform 5-mm thick coronal slices using a cradle.
- Visually compared reformatted volumetric T1-weighted preoperative MRI slices with photographs of tissue slices.
Main Results:
- Achieved a <2-mm difference in MRI-histology slice matching in 94% of cases (15/16).
- A 4-mm difference was noted in one case, with consensus reached by observers.
- All MRI-histology matches corresponded to resections visible on postoperative scans.
Conclusions:
- Uniform tissue slicing and careful handling ensure accurate histopathological analysis.
- The developed technique enables reliable correlation between MRI and histopathology.
- This method supports exploring the pathological basis of MRI findings in epilepsy.