title: Optic radiation mapping reduces the risk of visual field deficits in anterior temporal lobe resection.
abstract: Anterior temporal lobe resection (ATLR) is often complicated by superior quadrant visual field deficits (VFDs) because of damage to the anterior portion of the optic radiation (Meyer's loop). This study reports the evaluation of optic radiation mapping in protecting against VFDs in the ATLR. We retrospectively analyzed 52 patients with medically refractory temporal lobe epilepsy undergoing ATLR between January 2012 and December 2013. The surgical operations in Group I (n=32) were performed with the modified ATLR, and the operations in Group II (n=20) were aided by combining optic radiation mapping by diffusion tensor imaging, microscopic-based neuronavigation and the intraoperative magnetic resonance imaging (iMRI) technique. A t-test was used to compare the size of ATLR, and a chi square test was applied for the postoperative VFD and seizure outcomes. The optic radiation was reconstructed in all patients in Group II. The size of ATLR was 5.11±1.34 cm (3.3-8 cm), and 3.24±0.75 cm (2.2-4.8 cm) in Groups I and II, respectively; the size of ATLR was significantly smaller in Group II (F=9.803; P=0.00). The visual fields assessment by the Humphrey Field Analyser 30-2 test showed 27 patients (84.4%) in Group I suffered VFDs at 3 months post-operation, whereas only eight patients (40.0%) in Group II showed VFDs (Pearson chi square =11.01; P=0.001). The 6-month follow-up survey showed that 90.6% of patients in Group I achieved a good outcome (Engel class I-II), outperforming 85.0% in Group II, however, there was no statistically significant difference (chi square =0.382, P=0.581). This techniques of combining optic radiation mapping, microscopic-based neuronavigation and iMRI aided in precise mapping and hence reduction of the risk of visual field deficits in ATLR. The size of ATLR guided by optic radiation mapping was significantly smaller but the seizure outcome was not significantly affected.
authors.affiliation: Department of Neurosurgery, Chinese PLA General Hospital, Chinese PLA Postgraduate Medical School Beijing 100853, China.
authors.forename: Zhiqiang
authors.initials: Z
authors.lastname: Cui
authors.affiliation: Department of Neurosurgery, Chinese PLA General Hospital, Chinese PLA Postgraduate Medical School Beijing 100853, China.
authors.forename: Zhipei
authors.initials: Z
authors.lastname: Ling
authors.affiliation: Department of Neurosurgery, Chinese PLA General Hospital, Chinese PLA Postgraduate Medical School Beijing 100853, China.
authors.forename: Longsheng
authors.initials: L
authors.lastname: Pan
authors.affiliation: Department of Neurology, Hebei Province Luan County People's Hospital 063700, China.
authors.forename: Huifang
authors.initials: H
authors.lastname: Song
authors.affiliation: Department of Neurosurgery, Chinese PLA General Hospital, Chinese PLA Postgraduate Medical School Beijing 100853, China.
authors.forename: Xiaolei
authors.initials: X
authors.lastname: Chen
authors.affiliation: Department of Neurosurgery, Affiliated Tangshan People's Hospital & Tangshan Cancer Hospital, Hebei United University Tangshan 063001, China.
authors.forename: Wenjian
authors.initials: W
authors.lastname: Shi
authors.affiliation: Department of Neurosurgery, Affiliated Tangshan People's Hospital & Tangshan Cancer Hospital, Hebei United University Tangshan 063001, China.
authors.forename: Zhiqiang
authors.initials: Z
authors.lastname: Liu
authors.affiliation: Department of Neurosurgery, Chinese PLA General Hospital, Chinese PLA Postgraduate Medical School Beijing 100853, China.
authors.forename: Qun
authors.initials: Q
authors.lastname: Wang
authors.affiliation: Department of Neurosurgery, Chinese PLA General Hospital, Chinese PLA Postgraduate Medical School Beijing 100853, China.
authors.forename: Zhizhong
authors.initials: Z
authors.lastname: Zhang
authors.affiliation: Department of Neurosurgery, Chinese PLA General Hospital, Chinese PLA Postgraduate Medical School Beijing 100853, China.
authors.forename: Ye
authors.initials: Y
authors.lastname: Li
authors.affiliation: Department of Neurosurgery, Chinese PLA General Hospital, Chinese PLA Postgraduate Medical School Beijing 100853, China.
authors.forename: Xuejie
authors.initials: X
authors.lastname: Wang
authors.affiliation: Department of Radiology, Chinese PLA General Hospital, Chinese PLA Postgraduate Medical School Beijing 100853, China.
authors.forename: Yeqing
authors.initials: Y
authors.lastname: Qing
authors.affiliation: Department of Neurosurgery, Chinese PLA General Hospital, Chinese PLA Postgraduate Medical School Beijing 100853, China.
authors.forename: Xin
authors.initials: X
authors.lastname: Xu
authors.affiliation: Department of Neurosurgery, Chinese PLA General Hospital, Chinese PLA Postgraduate Medical School Beijing 100853, China.
authors.forename: Zhiqi
authors.initials: Z
authors.lastname: Mao
authors.affiliation: Department of Neurosurgery, Chinese PLA General Hospital, Chinese PLA Postgraduate Medical School Beijing 100853, China.
authors.forename: Bainan
authors.initials: B
authors.lastname: Xu
authors.affiliation: Department of Neurosurgery, Chinese PLA General Hospital, Chinese PLA Postgraduate Medical School Beijing 100853, China.
authors.forename: Xinguang
authors.initials: X
authors.lastname: Yu
authors.affiliation: Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University, Beijing Key Laboratory of Epilepsy Beijing 100093, China.
authors.forename: Guoming
authors.initials: G
authors.lastname: Luan
keywords: Intraoperative magnetic resonance imaging (iMRI); anterior temporal lobe resection (ATLR); optic radiation mapping; diffusion tensor imaging (DTI); visual field def﻿icits (VFD)