title: Preventing visual field deficits from neurosurgery.
abstract: OBJECTIVE
  We assessed whether display of optic radiation tractography during anterior temporal lobe resection (ATLR) for refractory temporal lobe epilepsy (TLE) can reduce the severity of postoperative visual field deficits (VFD) and increase the proportion of patients who can drive and whether correction for brain shift using intraoperative MRI (iMRI) is beneficial.
  
  
  METHODS
  A cohort of 21 patients underwent ATLR in an iMRI suite. Preoperative tractography of the optic radiation was displayed on the navigation and operating microscope displays either without (9 patients) or with (12 patients) correction for brain shift. VFD were quantified using Goldmann perimetry and eligibility to drive was assessed by binocular Esterman perimetry 3 months after surgery. Secondary outcomes included seizure freedom and extent of hippocampal resection. The comparator was a cohort of 44 patients who underwent ATLR without iMRI.
  
  
  RESULTS
  The VFD in the contralateral superior quadrant were significantly less (p = 0.043) with iMRI guidance (0%-49.2%, median 14.5%) than without (0%-90.9%, median 24.0%). No patient in the iMRI cohort developed a VFD that precluded driving whereas 13% of the non-iMRI cohort failed to meet UK driving criteria. Outcome did not differ between iMRI guidance with and without brain shift correction. Seizure outcome and degree of hippocampal resection were unchanged.
  
  
  CONCLUSIONS
  Display of the optic radiation with image guidance reduces the severity of VFD and did not affect seizure outcome or hippocampal resection. Correction for brain shift is possible but did not further improve outcome. Future work to incorporate tractography into conventional neuronavigation systems will make the work more widely applicable.
authors.affiliation: From the Epilepsy Society MRI Unit, Department of Clinical and Experimental Epilepsy (G.P.W., J.S., M.K.S., M.R.S., J.S.D.), and the Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation (M.J.W., C.M., L.M., J.T. , T.A.Y.), UCL Institute of Neurology; the UCL Centre for Medical Image Computing (P.D., M.M., S.O.); the Lysholm Department of Neuroradiology (M.J.W., C.M., L.M., J.T., T.A.Y.) and the Department of Neurosurgery (A.M., A.W.M.), National Hospital for Neurology and Neurosurgery; and Kings College London (D.J.L.), Institute of Psychiatry, Centre for Neuroimaging Sciences, London, UK. g.winston@ucl.ac.uk.
authors.forename: Gavin P
authors.initials: GP
authors.lastname: Winston
authors.affiliation: From the Epilepsy Society MRI Unit, Department of Clinical and Experimental Epilepsy (G.P.W., J.S., M.K.S., M.R.S., J.S.D.), and the Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation (M.J.W., C.M., L.M., J.T. , T.A.Y.), UCL Institute of Neurology; the UCL Centre for Medical Image Computing (P.D., M.M., S.O.); the Lysholm Department of Neuroradiology (M.J.W., C.M., L.M., J.T., T.A.Y.) and the Department of Neurosurgery (A.M., A.W.M.), National Hospital for Neurology and Neurosurgery; and Kings College London (D.J.L.), Institute of Psychiatry, Centre for Neuroimaging Sciences, London, UK.
authors.forename: Pankaj
authors.initials: P
authors.lastname: Daga
authors.affiliation: From the Epilepsy Society MRI Unit, Department of Clinical and Experimental Epilepsy (G.P.W., J.S., M.K.S., M.R.S., J.S.D.), and the Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation (M.J.W., C.M., L.M., J.T. , T.A.Y.), UCL Institute of Neurology; the UCL Centre for Medical Image Computing (P.D., M.M., S.O.); the Lysholm Department of Neuroradiology (M.J.W., C.M., L.M., J.T., T.A.Y.) and the Department of Neurosurgery (A.M., A.W.M.), National Hospital for Neurology and Neurosurgery; and Kings College London (D.J.L.), Institute of Psychiatry, Centre for Neuroimaging Sciences, London, UK.
authors.forename: Mark J
authors.initials: MJ
authors.lastname: White
authors.affiliation: From the Epilepsy Society MRI Unit, Department of Clinical and Experimental Epilepsy (G.P.W., J.S., M.K.S., M.R.S., J.S.D.), and the Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation (M.J.W., C.M., L.M., J.T. , T.A.Y.), UCL Institute of Neurology; the UCL Centre for Medical Image Computing (P.D., M.M., S.O.); the Lysholm Department of Neuroradiology (M.J.W., C.M., L.M., J.T., T.A.Y.) and the Department of Neurosurgery (A.M., A.W.M.), National Hospital for Neurology and Neurosurgery; and Kings College London (D.J.L.), Institute of Psychiatry, Centre for Neuroimaging Sciences, London, UK.
authors.forename: Caroline
authors.initials: C
authors.lastname: Micallef
authors.affiliation: From the Epilepsy Society MRI Unit, Department of Clinical and Experimental Epilepsy (G.P.W., J.S., M.K.S., M.R.S., J.S.D.), and the Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation (M.J.W., C.M., L.M., J.T. , T.A.Y.), UCL Institute of Neurology; the UCL Centre for Medical Image Computing (P.D., M.M., S.O.); the Lysholm Department of Neuroradiology (M.J.W., C.M., L.M., J.T., T.A.Y.) and the Department of Neurosurgery (A.M., A.W.M.), National Hospital for Neurology and Neurosurgery; and Kings College London (D.J.L.), Institute of Psychiatry, Centre for Neuroimaging Sciences, London, UK.
authors.forename: Anna
authors.initials: A
authors.lastname: Miserocchi
authors.affiliation: From the Epilepsy Society MRI Unit, Department of Clinical and Experimental Epilepsy (G.P.W., J.S., M.K.S., M.R.S., J.S.D.), and the Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation (M.J.W., C.M., L.M., J.T. , T.A.Y.), UCL Institute of Neurology; the UCL Centre for Medical Image Computing (P.D., M.M., S.O.); the Lysholm Department of Neuroradiology (M.J.W., C.M., L.M., J.T., T.A.Y.) and the Department of Neurosurgery (A.M., A.W.M.), National Hospital for Neurology and Neurosurgery; and Kings College London (D.J.L.), Institute of Psychiatry, Centre for Neuroimaging Sciences, London, UK.
authors.forename: Laura
authors.initials: L
authors.lastname: Mancini
authors.affiliation: From the Epilepsy Society MRI Unit, Department of Clinical and Experimental Epilepsy (G.P.W., J.S., M.K.S., M.R.S., J.S.D.), and the Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation (M.J.W., C.M., L.M., J.T. , T.A.Y.), UCL Institute of Neurology; the UCL Centre for Medical Image Computing (P.D., M.M., S.O.); the Lysholm Department of Neuroradiology (M.J.W., C.M., L.M., J.T., T.A.Y.) and the Department of Neurosurgery (A.M., A.W.M.), National Hospital for Neurology and Neurosurgery; and Kings College London (D.J.L.), Institute of Psychiatry, Centre for Neuroimaging Sciences, London, UK.
authors.forename: Marc
authors.initials: M
authors.lastname: Modat
authors.affiliation: From the Epilepsy Society MRI Unit, Department of Clinical and Experimental Epilepsy (G.P.W., J.S., M.K.S., M.R.S., J.S.D.), and the Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation (M.J.W., C.M., L.M., J.T. , T.A.Y.), UCL Institute of Neurology; the UCL Centre for Medical Image Computing (P.D., M.M., S.O.); the Lysholm Department of Neuroradiology (M.J.W., C.M., L.M., J.T., T.A.Y.) and the Department of Neurosurgery (A.M., A.W.M.), National Hospital for Neurology and Neurosurgery; and Kings College London (D.J.L.), Institute of Psychiatry, Centre for Neuroimaging Sciences, London, UK.
authors.forename: Jason
authors.initials: J
authors.lastname: Stretton
authors.affiliation: From the Epilepsy Society MRI Unit, Department of Clinical and Experimental Epilepsy (G.P.W., J.S., M.K.S., M.R.S., J.S.D.), and the Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation (M.J.W., C.M., L.M., J.T. , T.A.Y.), UCL Institute of Neurology; the UCL Centre for Medical Image Computing (P.D., M.M., S.O.); the Lysholm Department of Neuroradiology (M.J.W., C.M., L.M., J.T., T.A.Y.) and the Department of Neurosurgery (A.M., A.W.M.), National Hospital for Neurology and Neurosurgery; and Kings College London (D.J.L.), Institute of Psychiatry, Centre for Neuroimaging Sciences, London, UK.
authors.forename: Meneka K
authors.initials: MK
authors.lastname: Sidhu
authors.affiliation: From the Epilepsy Society MRI Unit, Department of Clinical and Experimental Epilepsy (G.P.W., J.S., M.K.S., M.R.S., J.S.D.), and the Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation (M.J.W., C.M., L.M., J.T. , T.A.Y.), UCL Institute of Neurology; the UCL Centre for Medical Image Computing (P.D., M.M., S.O.); the Lysholm Department of Neuroradiology (M.J.W., C.M., L.M., J.T., T.A.Y.) and the Department of Neurosurgery (A.M., A.W.M.), National Hospital for Neurology and Neurosurgery; and Kings College London (D.J.L.), Institute of Psychiatry, Centre for Neuroimaging Sciences, London, UK.
authors.forename: Mark R
authors.initials: MR
authors.lastname: Symms
authors.affiliation: From the Epilepsy Society MRI Unit, Department of Clinical and Experimental Epilepsy (G.P.W., J.S., M.K.S., M.R.S., J.S.D.), and the Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation (M.J.W., C.M., L.M., J.T. , T.A.Y.), UCL Institute of Neurology; the UCL Centre for Medical Image Computing (P.D., M.M., S.O.); the Lysholm Department of Neuroradiology (M.J.W., C.M., L.M., J.T., T.A.Y.) and the Department of Neurosurgery (A.M., A.W.M.), National Hospital for Neurology and Neurosurgery; and Kings College London (D.J.L.), Institute of Psychiatry, Centre for Neuroimaging Sciences, London, UK.
authors.forename: David J
authors.initials: DJ
authors.lastname: Lythgoe
authors.affiliation: From the Epilepsy Society MRI Unit, Department of Clinical and Experimental Epilepsy (G.P.W., J.S., M.K.S., M.R.S., J.S.D.), and the Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation (M.J.W., C.M., L.M., J.T. , T.A.Y.), UCL Institute of Neurology; the UCL Centre for Medical Image Computing (P.D., M.M., S.O.); the Lysholm Department of Neuroradiology (M.J.W., C.M., L.M., J.T., T.A.Y.) and the Department of Neurosurgery (A.M., A.W.M.), National Hospital for Neurology and Neurosurgery; and Kings College London (D.J.L.), Institute of Psychiatry, Centre for Neuroimaging Sciences, London, UK.
authors.forename: John
authors.initials: J
authors.lastname: Thornton
authors.affiliation: From the Epilepsy Society MRI Unit, Department of Clinical and Experimental Epilepsy (G.P.W., J.S., M.K.S., M.R.S., J.S.D.), and the Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation (M.J.W., C.M., L.M., J.T. , T.A.Y.), UCL Institute of Neurology; the UCL Centre for Medical Image Computing (P.D., M.M., S.O.); the Lysholm Department of Neuroradiology (M.J.W., C.M., L.M., J.T., T.A.Y.) and the Department of Neurosurgery (A.M., A.W.M.), National Hospital for Neurology and Neurosurgery; and Kings College London (D.J.L.), Institute of Psychiatry, Centre for Neuroimaging Sciences, London, UK.
authors.forename: Tarek A
authors.initials: TA
authors.lastname: Yousry
authors.affiliation: From the Epilepsy Society MRI Unit, Department of Clinical and Experimental Epilepsy (G.P.W., J.S., M.K.S., M.R.S., J.S.D.), and the Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation (M.J.W., C.M., L.M., J.T. , T.A.Y.), UCL Institute of Neurology; the UCL Centre for Medical Image Computing (P.D., M.M., S.O.); the Lysholm Department of Neuroradiology (M.J.W., C.M., L.M., J.T., T.A.Y.) and the Department of Neurosurgery (A.M., A.W.M.), National Hospital for Neurology and Neurosurgery; and Kings College London (D.J.L.), Institute of Psychiatry, Centre for Neuroimaging Sciences, London, UK.
authors.forename: Sebastien
authors.initials: S
authors.lastname: Ourselin
authors.affiliation: From the Epilepsy Society MRI Unit, Department of Clinical and Experimental Epilepsy (G.P.W., J.S., M.K.S., M.R.S., J.S.D.), and the Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation (M.J.W., C.M., L.M., J.T. , T.A.Y.), UCL Institute of Neurology; the UCL Centre for Medical Image Computing (P.D., M.M., S.O.); the Lysholm Department of Neuroradiology (M.J.W., C.M., L.M., J.T., T.A.Y.) and the Department of Neurosurgery (A.M., A.W.M.), National Hospital for Neurology and Neurosurgery; and Kings College London (D.J.L.), Institute of Psychiatry, Centre for Neuroimaging Sciences, London, UK.
authors.forename: John S
authors.initials: JS
authors.lastname: Duncan
authors.affiliation: From the Epilepsy Society MRI Unit, Department of Clinical and Experimental Epilepsy (G.P.W., J.S., M.K.S., M.R.S., J.S.D.), and the Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation (M.J.W., C.M., L.M., J.T. , T.A.Y.), UCL Institute of Neurology; the UCL Centre for Medical Image Computing (P.D., M.M., S.O.); the Lysholm Department of Neuroradiology (M.J.W., C.M., L.M., J.T., T.A.Y.) and the Department of Neurosurgery (A.M., A.W.M.), National Hospital for Neurology and Neurosurgery; and Kings College London (D.J.L.), Institute of Psychiatry, Centre for Neuroimaging Sciences, London, UK.
authors.forename: Andrew W
authors.initials: AW
authors.lastname: McEvoy
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D004833:Epilepsy, Temporal Lobe / Q000473:pathology / Q000601:surgery*; D005260:Female; D006624:Hippocampus / Q000473:pathology; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D038361:Neuronavigation / Q000379:methods*; D019635:Neurosurgical Procedures / Q000009:adverse effects*; D010468:Perceptual Disorders / Q000517:prevention & control*; D012640:Seizures / Q000473:pathology / Q000601:surgery; D013702:Temporal Lobe / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome; D014794:Visual Fields; D014795:Visual Pathways / Q000473:pathology / Q000601:surgery; D055815:Young Adult