title: Usefulness of diffusion tensor tractography in pediatric epilepsy surgery.
abstract: OBJECTIVE
  This study was conducted to assess the clinical relevance of diffusion tensor tractography (DTT) in pre- and post-operative evaluations of childhood epilepsy surgery.
  
  
  METHODS
  Seventy-two patients who received epilepsy surgery between March 2004 and July 2008 were retrospectively analyzed (M : F=40 : 32, ages of 3 months to 24 years, mean age=8.9 years). DTT was performed using a 3.0 T scanner and single-shot spin-echo echo-planar imaging with 32-different diffusion gradient directions. We reviewed the data focusing on the type of surgery, final pathological diagnosis, and how the DTT data were clinically used.
  
  
  RESULTS
  The most common form of childhood epilepsy surgery was complete resection of an epileptogenic lesion (n=52, 72.2%). The reported etiologies included cortical dysplasia (n=32, 44.4%), hippocampal sclerosis (n=9, 12.5%), brain tumors (n=7, 9.7%), and non-pathologic lesions (n=4, 5.6%) in the final diagnoses. Twenty-one dysplastic cortexes and four brain tumors involved an approximal relationship with the corticospinal tract (n=18), optic radiation (n=2), and arcuate fasciculus (n=5). Additionally, although DTT demonstrated white matter tracts clearly, DTT in the hippocampal sclerosis did not provide any additional information. In cases of callosotomy (n=18, 25%), post-operative DTT was utilized for the evaluation of complete resection in all patients. DTT information was not used in functional hemispherectomy (n=2, 2.8%).
  
  
  CONCLUSIONS
  Preoperatively, DTT was a useful technique in cases of cortical dysplasia and brain tumors, and in cases with callosotomy, postoperatively. DTT should be included among the routine procedures performed in management of epilepsy.
authors.affiliation: Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Seodaemun-gu, Seoul, Korea.
authors.forename: Mi-Jung
authors.initials: MJ
authors.lastname: Lee
authors.forename: Heung Dong
authors.initials: HD
authors.lastname: Kim
authors.forename: Joon Soo
authors.initials: JS
authors.lastname: Lee
authors.forename: Dong-Seok
authors.initials: DS
authors.lastname: Kim
authors.forename: Seung-Koo
authors.initials: SK
authors.lastname: Lee
mesh_terms: D000293:Adolescent; D000328:Adult; D001932:Brain Neoplasms / Q000473:pathology / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D056324:Diffusion Tensor Imaging / Q000379:methods*; D004827:Epilepsy / Q000473:pathology* / Q000601:surgery*; D005260:Female; D006624:Hippocampus / Q000473:pathology; D006801:Humans; D007223:Infant; D008297:Male; D012189:Retrospective Studies; D012598:Sclerosis / Q000473:pathology / Q000601:surgery; D012640:Seizures / Q000601:surgery; D016896:Treatment Outcome; D055815:Young Adult