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Updated: Apr 1, 2026
Anteromesial Temporal Lobectomy for Medically Intractable Temporal Lobe Epilepsy: An Operative Study
Published on: August 15, 2025
Connectome Reorganization Associated With Surgical Outcome in Temporal Lobe Epilepsy
Gong-Jun Ji1, Zhiqiang Zhang, Qiang Xu
1From the Laboratory of Cognitive Neuropsychology, Department of Medical Psychology, Anhui Medical University, Hefei (G-JJ); Center for Cognition and Brain Disorders and the Affiliated Hospital, Hangzhou Normal University (G-JJ, JW, WL); Zhejiang Key Laboratory for Research in Assessment of Cognitive Impairments, Hangzhou (G-JJ, JW, WL); Department of Medical Imaging, Jinling Hospital, Nanjing University School of Medicine (ZZ, QX, WW, GL); Department of Medical Imaging, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School (ZW); Department of Neurology, Jinling Hospital (FY); Department of Neurosurgery, Jinling Hospital, Nanjing University School of Medicine, Nanjing (KS); Department of Radiology, Taishan Medical University, Tai'an (QJ); and Key Laboratory for Neuroinformation of Ministry of Education, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, China (WL).
Abstract:
To identify the distinct pattern of anatomical network reorganization in surgically refractory mesial temporal lobe epilepsy (MTLE) patients using a longitudinal design. We collected longitudinal diffusion-weighted images of 19 MTLE patients before and after anterior temporal lobectomy. Patients were classified as seizure-free (SF) or nonseizure-free (NSF) at least 1 year after surgery. We constructed whole-brain anatomical networks derived from white matter tractography and evaluated network connectivity measures by graph theoretical analysis. The reorganization trajectories of network measures in SF and NSF patients were investigated by two-way mixed analysis of variance, with factors "group" (SF vs NSF) and "treatment" (presurgery vs postsurgery). Widespread brain structures showed opposite reorganization trajectories in FS and NSF groups (interaction effect). Most of them showed group difference before surgery and then converge after surgery, suggesting that surgery remodeled these structures into a similar status. Conversly, contralateral amygdala-planum-temporale and thalamic-parietal tracts showed higher connectivity strength in NSF than in SF patients after surgery, indicating maladaptive neuroplastic responses to surgery in NSF patients. Our findings suggest that surgical outcomes are associated not only with the preoperative pattern of anatomical connectivity, but also with connectome reconfiguration following surgery. The reorganization of contralateral temporal lobe and corticothalamic tracts may be particularly important for seizure control in MTLE.
