Brain Advance Access originally published online on September 7, 2006
Brain 2007 130(2):548-560; doi:10.1093/brain/awl232
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The extent of resection of FDG-PET hypometabolism relates to outcome of temporal lobectomy
1 The Departments of Medicine, Surgery, Radiology and Neurosciences, The Royal Melbourne Hospital The University of Melbourne, Parkville 2 Centre for Molecular Imaging, Peter MacCallum Cancer Centre East Melbourne, Victoria, Australia
Correspondence to: Dr Anita Vinton, The Department of Medicine, The University of Melbourne, Royal Parade, Parkville, Victoria 3050, Australia E-mail: abvinton1{at}optusnet.com.au
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.
Key Words: temporal lobe epilepsy; FDG-PET; temporal lobectomy outcome
Abbreviations: AED, anti-epileptic drug; AH, amygdalohippocampectomy; ATL, anterior temporal lobectomy; FDG, fluorodeoxyglucose; HS, hippocampal sclerosis; ROI, region of interest; SPM, statistical parametric mapping; TLE, temporal lobe epilepsy
Received February 25, 2006. Revised July 28, 2006. Accepted August 1, 2006.
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