White matter functional connectivity as an additional landmark for dominant temporal lobectomy

Area of Science:

• Neurosurgery
• Neuroanatomy
• Neuroimaging

Background:

• Dominant temporal lobectomy relies on anatomical knowledge but often overlooks subcortical white matter tracts.
• Damage to these tracts during surgery can lead to permanent deficits like aphasia.
• The precise 3D geometry of white matter fasciculi is not well-described, complicating surgical planning.

Purpose of the Study:

• To review recent findings on the anatomo-functional connectivity of the dominant temporal lobe's white matter.
• To discuss the implications of integrating white matter functional connectivity into temporal lobectomy procedures.
• To enhance surgical precision and reduce the risk of neurological deficits.

Main Methods:

• Review of recent scientific literature combining diffusion tensor imaging (DTI) tractography and intraoperative subcortical electrostimulation.
• Analysis of anatomical data from DTI for 3D visualization of white matter tracts.
• Correlation of functional mapping from electrostimulation with anatomical data.

Main Results:

• Diffusion tensor imaging (DTI) provides powerful 3D visualization of white matter fasciculi.
• Intraoperative subcortical electrostimulation effectively maps the function of these pathways.
• Combined DTI and electrostimulation data offer a comprehensive understanding of anatomo-functional connectivity.

Conclusions:

• Integrating white matter functional connectivity, derived from DTI and intraoperative stimulation, serves as a valuable additional landmark for dominant temporal lobectomy.
• This approach can improve surgical planning and potentially minimize the risk of permanent neurological deficits.
• Enhanced understanding of subcortical pathways is crucial for optimizing surgical outcomes.