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Related Experiment Video

Updated: Feb 8, 2026

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Assessing Corticospinal Tract Asymmetry in Unilateral Polymicrogyria.

O Foesleitner1, K-H Nenning1, T Traub-Weidinger1

  • 1From the Departments of Biomedical Imaging and Image-Guided Therapy (O.F., K.-H.N., T.T.-W., D.P., G.K.).

AJNR. American Journal of Neuroradiology
|June 30, 2018
PubMed
Summary

Corticospinal tract asymmetry in unilateral polymicrogyria is a reliable predictor of preserved motor function after hemispherectomy. This visual assessment, particularly at the midbrain, aids surgical planning for these congenital brain lesions.

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Area of Science:

  • Neuroscience
  • Radiology
  • Pediatric Neurology

Background:

  • Congenital brain lesions like unilateral polymicrogyria can impact motor function.
  • Corticospinal tract (CST) asymmetry is a known prognostic marker for motor outcomes post-hemispherectomy.

Purpose of the Study:

  • To evaluate CST asymmetry as a prognostic marker in unilateral polymicrogyria.
  • To establish a clinically feasible method for assessing CST asymmetry in these patients.

Main Methods:

  • Retrospective analysis of 9 patients with unilateral polymicrogyria.
  • Assessment of CST asymmetry using T1-weighted imaging (T1WI) and diffusion tensor imaging (DTI).
  • Quantitative measurements of brain stem and thalamus volumes, and DTI parameters of the internal capsule.
  • Interrater reliability assessment of CST asymmetry at four levels.
  • DTI tractography to identify the motor cortex, with functional MRI (fMRI) in select cases.

Main Results:

  • Excellent correlation between visual and quantitative CST asymmetry assessment (P = .007 for T1WI, P = .023 for DTI).
  • Highest interrater reliability for CST asymmetry at the midbrain level (Cohen κ = 0.77, P = .018).
  • Three patients with marked preoperative CST asymmetry underwent hemispherectomy with stable postsurgical motor function.
  • DTI tractography successfully identified the presumed motor cortex in all 9 patients, confirmed by fMRI in 3.

Conclusions:

  • Visual assessment of CST asymmetry using T1WI and DTI maps at the midbrain is reliable for unilateral polymicrogyria.
  • Significant CST asymmetry predicts preserved motor function following hemispherectomy.
  • DTI tractography serves as a valuable tool for guiding towards the motor cortex within polymicrogyria.