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Fig. 1 (A) SPM results of pre- and postoperative FDG-PET images. A postsurgical decrease in glucose metabolism was observed in the ipsilateral caudate nucleus, thalamus (I), fusiform gyrus and the posterior region of the insula (II), whereas a postsurgical increase in glucose metabolism was observed in the anterior region of the insula, temporal stem white matter, inferior precentral gyrus, ipsilateral midbrain (III) and anterior cingulate gyrus (IV) ipsilateral to resection (familywise error-corrected, P < 0.05). SPM results were overlaid on the brain MRI of a single normal control. Red-yellow colour means increased metabolism; blue colour indicates decreased metabolism. (B) Subtraction between pre- and postsurgical FDG-PET images in individual patients. I and II show postoperatively decreased glucose metabolism in the caudate nucleus after right temporal lobectomy (I) and in the fusiform gyrus after left temporal lobectomy (II). III and IV show postoperatively increased glucose metabolism in the left anterior insular cortex and small areas of the right anterior temporal region after left temporal lobectomy (III) and in the left temporal stem white matter and midbrain and in bilateral thalami after left temporal lobectomy (IV). (C) SISCOM (subtraction ictal–interictal SPECT co-registered to MRI) result of a patient with left mesial TLE. Ictal hyperperfusion was observed in the left mesial temporal region (amygdala–hippocampus), left midbrain and cerebellum (I
III), and in bilateral basal ganglia, left anterior insula and left temporal stem white matter (IV).
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