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

H Duffau, M T. de Schotten, E Mandonnet
Journal of Neurology, Neurosurgery & Psychiatry. 2008-05-01; 79(5): 492-495
DOI: 10.1136/jnnp.2007.121004

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1. J Neurol Neurosurg Psychiatry. 2008 May;79(5):492-5. doi:

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

Duffau H(1), Thiebaut de Schotten M, Mandonnet E.

Author information:
(1)Department of Neurosurgery, Hôpital Gui de Chauliac, CHU de Montpellier, 80
avenue Augustin Fliche, 34295 Montpellier Cedex 5, France.

Dominant temporal lobectomy is classically performed based on two criteria: a
perfect knowledge of the temporo-mesial microsurgical anatomy and cortical
landmarks laterally. However, the functional anatomy of the subcortical white
matter tracts is taken into account less, despite the risk of inducing a
permanent deficit (especially aphasia) if damaged. Even if Klinger’s technique
allows dissection of fibres on cadaveric specimens, the exact three dimensional
geometry of these fasciculi remains poorly described. Tractography, based on
diffusion tensor imaging (DTI), is a powerful tool to build three dimensional
images of several fasciculi, helping neurosurgeons to create a mental
representation of their relationships. Moreover, intraoperative subcortical
electrostimulation enables mapping of the function of these pathways. Here we
review the recent findings on the white matter anatomo-functional connectivity of
the dominant temporal lobe, based on combined anatomical data provided by DTI and
functional information provided by intraoperative stimulation. We then discuss
their implications for temporal lobectomy, by using white matter functional
connectivity as an additional landmark.

DOI: 10.1136/jnnp.2007.121004
PMID: 18408087 [Indexed for MEDLINE]

Auteurs Bordeaux Neurocampus