Journal Article

The extent of resection of FDG-PET hypometabolism relates to outcome of temporal lobectomy

Anita B. Vinton, Ross Carne, Rodney J. Hicks, Patricia M. Desmond, Christine Kilpatrick, Andrew H. Kaye and Terence J. O'Brien

in Brain

Published on behalf of The Guarantors of Brain

Volume 130, issue 2, pages 548-560
Published in print February 2007 | ISSN: 0006-8950
Published online September 2006 | e-ISSN: 1460-2156 | DOI: http://dx.doi.org/10.1093/brain/awl232
The extent of resection of FDG-PET hypometabolism relates to outcome of temporal lobectomy

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A significant minority of patients undergoing surgery for medically refractory non-lesional temporal lobe epilepsy (TLE) continue to have seizures, but the reasons for this are uncertain. Fluorodeoxyglucose (FDG) PET shows hypometabolism in a majority of patients with non-lesional TLE, even in the absence of hippocampal atrophy. We examined whether the extent of resection of the area of FDG-PET hypometabolism influenced outcome following surgery for non-lesional TLE. Twenty-six patients who underwent temporal lobectomy for medically refractory TLE with at least 12 months follow-up were studied. The preoperative FDG-PET was compared with 20 non-epileptic controls using SPM99 to identify regions of significant hypometabolism (P < 0.0005, cluster > 200). This image was then co-registered to the postoperative MRI scan. The volume of the FDG-PET hypometabolism that lay within the area of the resected temporal lobe was calculated. The volume of temporal lobe resected was also calculated. Patients with a good outcome had a greater proportion of the total FDG-PET hypometabolism volume resected than those with a poor outcome (24.1% versus 11.8%, P = 0.02). There was no significant difference between the groups in the volume of temporal lobe resected (P = 0.86). Multivariate regression demonstrated that the extent of resection of the hypometabolism significantly correlated with outcome (P = 0.03), independent of the presence of hippocampal sclerosis (P = 0.03) and total brain volume of hypometabolism (P = 0.45).

The extent of resection of the region of hypometabolism on the preoperative FDG-PET is predictive of outcome following surgery for non-lesional TLE. Strategies that tailor resection extent to regional hypometabolism may warrant further evaluation.

Keywords: temporal lobe epilepsy; FDG-PET; temporal lobectomy outcome

Journal Article.  7380 words.  Illustrated.

Subjects: Neurology ; Neuroscience

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