Clinical Utilization of Structural Connectomics in LITT for Temporal Lobe Epilepsy

Introduction: Structural connectomics (SC) has offered much insight into brain networks but is only recently being applied in routine neurosurgical clinical care, primarily in the arena of mapping brain networks prior to tumor or lesional resection. SC holds great potential for adding additional insights to routine surgical epilepsy. We demonstrate here a potential clinical application of SC in mesial temporal lobe laser interstitial thermal therapy (LITT) for epilepsy.

Methods: Omniscient Quicktome software was used to parcellate SC for two patients undergoing mesial temporal lobe ablation for epilepsy. Tracts of interest such as the ILF, optic radiation, and language pathways were generated. Additionally, structural parcellations of amygdala and mesial hippocampal structures showing local connectivity were also generated. Surgical plans on the ROSA robot were designed keeping the tracts in mind as a posterior boundary.

Results: Patients underwent uneventful temporal LITT procedures without complications and had uneventful postoperative courses. Arrest in seizure activity at 3-month postoperative follow-up was noted. Qualitative evaluations of the relevant imaging were performed pre and post LITT showing structural changes in connectivity when comparing preoperative SC to imaging obtained immediately post LITT. Results are limited due to software restrictions on performing seed-based mapping. Additionally, pre or post operative resting state functional imaging to supplement the SC evaluation would add additional value to this technique and is something we aim to implement in the future.

Conclusion : The clinical application of SC may aid in the planning of mesial temporal LITT procedures and help better understand changes in epilepsy networks post ablation. Further evaluation of clinically available products in a prospective fashion with correlation to clinical outcomes may help to better establish the roles of this technology in routine surgical epilepsy care.