Effects of unilateral cortical resection of the visual cortex on bilateral human white matter

Abstract

Children with unilateral resections of ventral occipito-temporal cortex (VOTC) typically do not evince visual perceptual impairments, even when relatively large swathes of VOTC are resected. In search of possible explanations for this behavioral competence, we evaluated white matter microstructure and connectivity in eight pediatric epilepsy patients following unilateral cortical resection and 15 age-matched controls. To uncover both local and broader resection-induced effects, we analyzed tractography data using two complementary approaches. First, the microstructural properties were measured in the inferior longitudinal and the inferior fronto-occipital fasciculi, the major VOTC association tracts. Group differences were only evident in the ipsilesional, and not in the contralesional, hemisphere, and single-subject analyses revealed that these differences were limited to the site of the resection. Second, graph theory was used to characterize the connectivity of the contralesional occipito-temporal regions. There were no changes to the network properties in patients with left VOTC resections nor in patients with resections outside the VOTC, but altered network efficiency was observed in two cases with right VOTC resections. These results suggest that, in many, although perhaps not all, cases of unilateral VOTC resections in childhood, the white matter integrity in the preserved contralesional hemisphere along with residual neural activity might be sufficient for normal visual perception.\n\nHighlightsO_LIThere is well-circumscribed white matter damage in pediatric epilepsy after surgery\nC_LIO_LIWhite matter pathways are normal distal as well as contralesional to the resection\nC_LIO_LIContralesional network properties differ after left or right hemisphere resection\nC_LIO_LIPreserved cortex and white matter may be sufficient for normal perception\nC_LI