Close
Supervisor: Jon Clayden, Martin Tisdall
Project Description:
Background: Surgery is a safe and effective treatment option for certain drug-resistant epilepsies in children, with a better chance of delivering seizure freedom than alternative therapies (Dwivedi et al., 2017). However, the extent of any resection needs to be balanced against the possibility of damage to nearby eloquent tissue. Diffusion magnetic resonance imaging (dMRI) and “tractography” can be used both preoperatively and intraoperatively to map important white matter tracts such as the optic radiations (subserving visual function; e.g.,Winston et al., 2011) or corticospinal tracts (gross motor function). Tractography is increasingly used by neurosurgical teams in the UK, but it faces practical difficulties relating to interpretation and the time and human resources required to use it effectively (Toescu et al., 2021).
Aims/Objectives: We have developed an alternative to conventional tractography (“tractfinder”) which can map eloquent white matter structures of interest rapidly and in fewer steps than the dominant streamline-based approach (F. Young et al., 2024). Moreover this technique was designed with neurosurgical usage in mind explicitly, and is able to mimic the effects of space-occupying lesions so as to account for their distorting effects (F. E. Young et al., 2022). The key aim of this project is to develop this approach into the domain of epilepsy surgery, including intraoperative use.
Methods: The student will work alongside imaging scientists and relevant clinical teams to apply and improve the tractfinder technique for application to epilepsy surgery. This will involve methodological development, attending clinical multidisciplinary team meetings, gathering and processing dMRI data and writing up and disseminating findings.
Timeline: Literature review and familiarisation with existing method (months 1–6); work on pre surgical epilepsy imaging to evaluate the technique as it stands and scope for improvements (months 7–12); iterative methodological work on available imaging, and evaluation alongside clinical teams (months 13–24); work towards clinical acceptance and integration (months 25–30); thesis write-up and submission (months 31–36).
References
- Dwivedi, R., Ramanujam, B., Chandra, P. S., Sapra, S., Gulati, S., Kalaivani, M., Garg, A., Bal, C. S., Tripathi, M., Dwivedi, S. N., Sagar, R., Sarkar, C., & Tripathi, M. (2017). Surgery for Drug Resistant Epilepsy in Children. The New England Journal of Medicine, 377(17), 1639–1647. https://doi.org/10.1056/NEJMoa1615335
- Toescu, S. M., Hales, P. W., Tisdall, M. M., Aquilina, K., & Clark, C. A. (2021). Neurosurgical applications of tractography in the UK. British Journal of Neurosurgery, 35(4), 424–429. https://doi.org/10.1080/02688697.2020.1849542
- Winston, G. P., Mancini, L., Stretton, J., Ashmore, J., Symms, M. R., Duncan, J. S., & Yousry, T. A. (2011). Diffusion tensor imaging tractography of the optic radiation for epilepsy surgical planning: a comparison of two methods. Epilepsy Research, 97(1–2), 124–132. https://doi.org/10.1016/j.eplepsyres.2011.07.019
- Young, F., Aquilina, K., Seunarine, K. K., Mancini, L., Clark, C. A., & Clayden, J. D. (2024). Fibre orientation atlas guided rapid segmentation of white matter tracts. Human Brain Mapping, 45(2), e26578. https://doi.org/10.1002/hbm.26578
- Young, F. E., Aquilina, K., Clark, C. A., & Clayden, J. D. (2022). Fibre tract segmentation for intraoperative diffusion MRI in neurosurgical patients using tract-specific orientation atlas and tumour deformation modelling. International Journal of Computer Assisted Radiology and Surgery, 17(9), 1559–1567. https://doi.org/10.1007/s11548-022-02617-z
Contact Information:
Jon Clayden