Detection of visual field defects in patients after anterior temporal lobectomy for mesial temporal sclerosis—establishing eligibility to drive

Pathak-Ray, Vanita; Ray, Amit; Walters, R F; Hatfield, R.

doi:10.1038/sj.eye.6700152

Cited by 50 publications

(41 citation statements)

References 11 publications

(12 reference statements)

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“…A study in Wales found that only 50% of 14 patients postϪtemporal lobectomy would be able to pass the visual examination required to drive. 2 In Australia, a person with a quadrantanopia or hemianopia is ineligible for an unconditional driver's license according to the "Medical Standards for Licensing and Clinical Management Guidelines" of the Austroads document. 3 Ironically, a patient may be freed of driving constraints due to epilepsy yet be relegated to a lifetime prohibition of driving due to an acquired VFD.…”

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confidence: 99%

Challenges of the Anatomy and Diffusion Tensor Tractography of the Meyer Loop

Mandelstam

2012

AJNR Am J Neuroradiol

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SUMMARY:This review addresses the complex and often controversial anatomy of the anterior bundle of the OR, also known as the Meyer loop. Before the advent of MR imaging, 2 main types of studies attempted to ascertain the "safe" distance for anterior temporal lobe resection to avoid postsurgical VFDs. There were those based first on postoperative VFD correlation and second on anatomic dissection studies. In the past decade, noninvasive diffusion MR imagingϪbased tractography techniques have been developed in an attempt to elucidate white matter connectivity. Although many of these techniques are still experimental, there are some clinical situations for which they may prove to be very helpful if properly performed and validated. The motivation for this review was to improve the outcome of patients with TLE undergoing temporal lobectomy: Would having anatomic information about the OR available to the neurosurgeon decrease the risk of postsurgical VFDs?ABBREVIATIONS: ATL ϭ anterior temporal lobectomy; CSD ϭ constrained spherical deconvolution; DT-FT ϭ diffusion tensor fiber tractography; DTI ϭ diffusion tensor imaging; FA ϭ fractional anisotropy; LGB ϭ lateral geniculate body; LGN ϭ lateral geniculate nucleus; OR ϭ optic radiations; TLE ϭ temporal lobe epilepsy; TP ϭ temporal pole; VFD ϭ visual field deficit T emporal lobectomy has become a common and successful form of epilepsy surgery, which can stop the occurrence of TLE in most appropriate patients who are refractory to medical treatment. A common complication of ATL is the occurrence of a postoperative VFD due to disruption of the OR, specifically the anterior bundle, the Meyer loop. Unfortunately, the extent of a postoperative VFD cannot be accurately predicted by conventional MR imaging or from the extent of the resection performed. Risk of damage to the OR is substantial because the tracts are not separately visible under the operating microscope. As the Meyer loop transmits visual information from the contralateral superior field of both eyes, damage will cause homonymous superior quadrantanopia.

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confidence: 99%

Challenges of the Anatomy and Diffusion Tensor Tractography of the Meyer Loop

Mandelstam

2012

AJNR Am J Neuroradiol

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“…Functionally significant VFDs were noted in 4-50% of patients after temporal lobectomy, resulting in their inability to drive and adversely affecting quality of life despite seizure freedom [12,13,14,15]. VFDs were also found in 50-62.5% of patients after radiosurgery for MTLE [16,17].…”

Section: Introductionmentioning

confidence: 99%

Optic Radiation Tractography and Visual Field Deficits in Laser Interstitial Thermal Therapy for Amygdalohippocampectomy in Patients with Mesial Temporal Lobe Epilepsy

Yin

Thompson

Drees

et al. 2017

Stereotact Funct Neurosurg

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Background/Aims: Laser interstitial thermal therapy (LITT) has become an alternative to open-resective surgery for refractory mesial temporal lobe epilepsy (MTLE). Occurrence of visual field defects (VFDs) following open surgery for MTLE is reported at 52-100%. We examined the rate of VFDs following LITT for amygdalohippocampectomy (AHE) and correlated the occurrence of VFDs with damage to the optic radiations, assessed by diffusion tensor tractography (DTI). Methods: We performed a retrospective analysis of 5 patients who underwent LITT-AHE for medically refractory MTLE. We examined the association between VFDs and optic radiation damage by correlating postprocedural visual field testing with qualitative assessment of optic radiation fiber tracts. Results: Postoperative assessments showed that 4 patients had normal visual field testing, and 1 had a right superior quadrantanopsia (20%). We performed 3-dimensional reconstruction of the optic radiation, laser probe trajectory, and ablation volume. Damage to Meyer's loop was determined consistent with the VFD. Conclusions: Short-term follow-up in our series suggests that laser ablation AHE may be associated with a lower rate of VFD than has been reported for open AHE. Our results suggest that incorporating optic radiation mapping through DTI may preoperatively help to minimize the risk of VFD following laser ablation AHE.

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“…Driving licences have been withdrawn on the basis of vigabatrin-related VF loss [130, 153]. In the UK, the patients may get their licence back once they adapt.…”

Section: Disorders With Pcsmentioning

confidence: 99%

“…Other procedures associated with iatrogenic VF loss include radiation and ENT surgery of the sinuses, neuro- and cardiovascular surgery [42, 87, 103, 108, 123, 137, 153, 162, 183, 188, 200]. …”

Section: Disorders With Pcsmentioning

confidence: 99%