The 3D model allowed a detailed discussion of the aspects of the surgical approach by having tissues of different consistencies and resistances, and also predicting with millimetric precision the bilateral orbitotomy measurements. Moreover, it was a fundamental and valuable factor in the multidisciplinary preoperative discussion. This approach allowed reducing the time of surgery, accurately planning the location of the osteotomies and precontouring the osteosynthesis material. 3D models can be very helpful tools in planning complex craniofacial operative procedures.
Summary:Mesial temporal lobe epilepsy (MTLE) is frequently associated with refractory seizures and pathologic features of hippocampal sclerosis (HS). Quantitative magnetic resonance imaging (MRI) techniques can improve the detection and quantification of HS. The objective of this study was to evaluate whether MRI texture analysis can detect hippocampal abnormalities in patients with pathologically proven HS.Methods: Nineteen consecutive patients who underwent surgery for refractory unilateral MTLE and had HS diagnosed on histopathology (12 right and seven left) had their preoperative MRIs evaluated. We performed texture analysis in 3-mm coronal T 1 -IR MRIs, focusing on the hippocampal head, by using the software MAZDA. Data were compared with those of a group of 78 normal hippocampi from 39 healthy adult volunteers through multivariate analysis of variance and selection of the most significant texture parameters.Results: Overall, almost all parameters of texture could discriminate the group of hippocampi with HS and the group of contralateral hippocampi from the group of normal hippocampi, but the post hoc comparison showed no differences between HS and contralateral hippocampi.Conclusions: These results provide evidence of texture alteration in MRIs of hippocampi with HS and corroborate the hypothesis of bilaterality of hippocampal damage in patients with MTLE, but further studies are needed to investigate the lateralization power of texture analysis. Key Words: Epilepsy-MRI-Texture-Hippocampal sclerosis.Hippocampal sclerosis (HS) is the most common underlying pathology in adult patients with mesial temporal lobe epilepsy (MTLE). Neuronal loss also may extend to amygdala and parahippocampal gyrus, characterizing the typical pattern of mesial temporal sclerosis (MTS). MTS is found in most surgical specimens from operated-on patients with refractory MTLE and is associated with an excellent surgical prognosis (1-3).Magnetic resonance imaging (MRI) hallmarks of HS are reduced volume and increased T 2 internal signal of the hippocampal structure (4). These findings have prompted application of more sensitive quantitative techniques, such as hippocampal volumetry and T 2 relaxometry, for detection of subtle HS (5-7).Texture analysis of MR images is a quantitative method that can be used to detect and quantify structural abnormalities in different tissues (8,9). It makes it possible to assess the degree of gray-tone modifications and the alterations of gray-tone spatial distribution in a given anatomic region of interest. This gray-tone variation is thought to correspond to underlying functional and anatomic changes (10). In this setting, texture analysis may be sensitive to detect subtle changes in MRI and to extract more information than does visual assessment.Texture analysis has recently been performed to evaluate hippocampal formation in T 2 -weighted images acquired in a 0.28-T scan, and 6-mm axial slices (11). However, no previous studies evaluated the texture MRI features of pathologically proven HS.The purpo...
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