• Ashalatha Radhakrishnan, Jija S James, Chandrasekharan Kesavadas, Bejoy Thomas, Biji Bahuleyan, Mathew Abraham, and Kurupath Radhakrishnan.
• R. Madhavan Nayar Center for Comprehensive Epilepsy Care, Sree Chitra Tirunal Institute for MedicalSciences and Technology, Trivandrum, Kerala, India.
• Epilepsy Res. 2011 Nov 1;97(1-2):52-63.

PurposeTo assess the utility of diffusion tensor imaging tractography (DTIT) in decision making in patients considered for extratemporal resective epilepsy surgery.MethodsWe subjected 49 patients with drug-resistant focal seizures due to lesions located in frontal, parietal and occipital lobes to DTIT to map the white matter fiber anatomy in relation to the planned resection zone, in addition to routine presurgical evaluation. We stratified our patients preoperatively into different grades of risk for anticipated neurological deficits as judged by the distance of the white matter tracts from the resection zones and functional cortical areas.ResultsThirty-seven patients underwent surgery; surgery was abandoned in 12 (24.5%) patients because of the high risk of postoperative neurological deficit. DTIT helped us to modify the surgical procedures in one-fourth of occipital, one-third of frontal, and two-thirds of parietal and multilobar resections. Overall, DTIT assisted us in surgical decision making in two-thirds of our patients.ConclusionsDTIT is a noninvasive imaging strategy that can be used effectively in planning resection of epileptogenic lesions at or close to eloquent cortical areas. DTIT helps in predicting postoperative neurological outcome and thereby assists in surgical decision making and in preoperative counseling of patients with extratemporal focal epilepsies.Copyright © 2011 Elsevier B.V. All rights reserved.

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