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Journal of Neurology, Neurosurgery, and Psychiatry 2008;79:492-495; doi:10.1136/jnnp.2007.121004
Copyright © 2008 by the BMJ Publishing Group Ltd.
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REVIEW

White matter functional connectivity as an additional landmark for dominant temporal lobectomy

H Duffau1,2,3, M Thiebaut de Schotten4,5,6, E Mandonnet2,7

1 Department of Neurosurgery, Hôpital Gui de Chauliac, Montpellier, France
2 INSERM U678, Hôpital de la Salpêtrière, Paris, France
3 Laboratoire de la Cognition et du Comportement, FRE 2987 (CNRS/Université de Paris V René Descartes), Institut de Psychologie, Boulogne Billancourt, France
4 INSERM Unit 610, Hôpital de la Salpêtrière, Paris, France
5 Université Pierre et Marie Curie-Paris 6, Paris, France
6 IFR 70, Hôpital de la Salpêtrière, Paris, France
7 Department of Neurosurgery, Hôpital Lariboisière, Paris, France

Correspondence to:
Dr H Duffau, Department of Neurosurgery, Hôpital Gui de Chauliac, CHU de Montpellier, 80 avenue Augustin Fliche, 34295 Montpellier Cedex 5, France; h-duffau{at}chu-montpellier.fr

Dominant temporal lobectomy is classically performed based on two criteria: a perfect knowledge of the temporo-mesial microsurgical anatomy and cortical landmarks laterally. However, the functional anatomy of the subcortical white matter tracts is taken into account less, despite the risk of inducing a permanent deficit (especially aphasia) if damaged. Even if Klinger’s technique allows dissection of fibres on cadaveric specimens, the exact three dimensional geometry of these fasciculi remains poorly described. Tractography, based on diffusion tensor imaging (DTI), is a powerful tool to build three dimensional images of several fasciculi, helping neurosurgeons to create a mental representation of their relationships. Moreover, intraoperative subcortical electrostimulation enables mapping of the function of these pathways. Here we review the recent findings on the white matter anatomo-functional connectivity of the dominant temporal lobe, based on combined anatomical data provided by DTI and functional information provided by intraoperative stimulation. We then discuss their implications for temporal lobectomy, by using white matter functional connectivity as an additional landmark.






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Copyright © 2008 by the BMJ Publishing Group Ltd.