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The authors sought to determine how well the suggested margin would have maximized occurrence of postoperative seizure freedom (benefit) and minimized occurrence of postoperative neurological deficits (risk).<\/jats:p><\/jats:sec><jats:sec><jats:title>METHODS<\/jats:title><jats:p>The study included 77 pediatric patients with drug-resistant focal epilepsy (age 10.0 \u00b1 4.9 years) who underwent resection of their presumed epileptogenic zone. In preoperative DWI tractography from the resected hemisphere, 9 axonal pathways, C<jats:sub>i=1\u20139<\/jats:sub>, were identified using DWI-MAP as follows: C<jats:sub>1\u20133<\/jats:sub> supporting face, hand, and leg motor areas; C<jats:sub>4<\/jats:sub> connecting Broca\u2019s and Wernicke\u2019s areas; C<jats:sub>5\u20138<\/jats:sub> connecting Broca\u2019s, Wernicke\u2019s, parietal, and premotor areas; and C<jats:sub>9<\/jats:sub> connecting the occipital lobe and lateral geniculate nucleus. For each C<jats:sub>i<\/jats:sub>, the resection margin, d<jats:sub>i<\/jats:sub>, was measured by the minimal Euclidean distance between the voxels of C<jats:sub>i<\/jats:sub> and the resection boundary determined by spatially coregistered postoperative MRI. If C<jats:sub>i<\/jats:sub> was resected, d<jats:sub>i<\/jats:sub> was assumed to be negative (calculated as \u20131 \u00d7 average Euclidean distance between every voxel inside the resected C<jats:sub>i<\/jats:sub> volume, r<jats:sub>i<\/jats:sub>). Kalman filter prediction was then used to estimate an optimal resection margin, d*<jats:sub>i<\/jats:sub>, to balance benefit and risk by approximating the relationship between d<jats:sub>i<\/jats:sub> and r<jats:sub>i<\/jats:sub>. Finally, the authors defined the preservation zone of C<jats:sub>i<\/jats:sub> that can balance the probability of benefit and risk by expanding the cortical area of C<jats:sub>i<\/jats:sub> up to d*<jats:sub>i<\/jats:sub> on the 3D cortical surface.<\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS<\/jats:title><jats:p>In the whole group (n = 77), nonresection of the preoperative preservation zone (i.e., actual resection margin d*<jats:sub>i<\/jats:sub> greater than the Kalman filter\u2013defined d*<jats:sub>i<\/jats:sub>) accurately predicted the absence of postoperative motor (d*<jats:sub>1\u20133<\/jats:sub>: 0.93 at seizure-free probability of 0.80), language (d*<jats:sub>4\u20138<\/jats:sub>: 0.91 at seizure-free probability of 0.81), and visual deficits (d*<jats:sub>9<\/jats:sub>: 0.90 at seizure-free probability of 0.75), suggesting that the preservation of preoperative C<jats:sub>i<\/jats:sub> within d*<jats:sub>i<\/jats:sub> supports a balance between postoperative functional deficit and seizure freedom. The subsequent subgroup analyses found that preservation of preoperative C<jats:sub>i<\/jats:sub> <jats:sub>=1\u20134,9<\/jats:sub> within d*<jats:sub>i<\/jats:sub> <jats:sub>=1\u20134,9<\/jats:sub> may provide accurate deficit predictions independent of age and seizure frequency, suggesting that the DWI-based surgical margin can be effective for surgical planning even in young children and across a range of epilepsy severity.<\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSIONS<\/jats:title><jats:p>Integrating DWI-MAP analysis with Kalman filter prediction may help guide epilepsy surgery by visualizing the margins of the eloquent white matter pathways to be preserved.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2019.4.peds1994","type":"journal-article","created":{"date-parts":[[2019,7,5]],"date-time":"2019-07-05T21:53:42Z","timestamp":1562363622000},"page":"293-305","source":"Crossref","is-referenced-by-count":5,"title":["Novel diffusion tractography methodology using Kalman filter prediction to improve preoperative benefit-risk analysis in pediatric epilepsy surgery"],"prefix":"10.3171","volume":"24","author":[{"given":"Min-Hee","family":"Lee","sequence":"first","affiliation":[{"name":"Departments of Pediatrics,"},{"name":"Translational Imaging Laboratory, Children\u2019s Hospital of Michigan, Detroit, Michigan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nolan B.","family":"O\u2019Hara","sequence":"additional","affiliation":[{"name":"Translational Neuroscience Program, Wayne State University School of Medicine, Detroit; and"},{"name":"Translational Imaging Laboratory, Children\u2019s Hospital of Michigan, Detroit, Michigan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hirotaka","family":"Motoi","sequence":"additional","affiliation":[{"name":"Departments of Pediatrics,"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aimee F.","family":"Luat","sequence":"additional","affiliation":[{"name":"Departments of Pediatrics,"},{"name":"Neurology, and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Csaba","family":"Juh\u00e1sz","sequence":"additional","affiliation":[{"name":"Departments of Pediatrics,"},{"name":"Neurology, and"},{"name":"Neurosurgery, and"},{"name":"Translational Neuroscience Program, Wayne State University School of Medicine, Detroit; and"},{"name":"Translational Imaging Laboratory, Children\u2019s Hospital of Michigan, Detroit, Michigan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sandeep","family":"Sood","sequence":"additional","affiliation":[{"name":"Neurosurgery, and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eishi","family":"Asano","sequence":"additional","affiliation":[{"name":"Departments of Pediatrics,"},{"name":"Neurology, and"},{"name":"Translational Neuroscience Program, Wayne State University School of Medicine, Detroit; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jeong-Won","family":"Jeong","sequence":"additional","affiliation":[{"name":"Departments of Pediatrics,"},{"name":"Neurology, and"},{"name":"Translational Neuroscience Program, Wayne State University School of Medicine, Detroit; and"},{"name":"Translational Imaging Laboratory, Children\u2019s Hospital of Michigan, Detroit, Michigan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"key":"b1","series-title":"Stat Sci","doi-asserted-by":"publisher","first-page":"131","DOI":"10.1214\/ss\/1177011454","article-title":"A survey of exact inference for contingency tables","volume":"7","author":"Agresti A","year":"1992","unstructured":"Agresti A: A survey of exact inference for contingency tables. 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