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Acta Neurochir (Wien). 2015 Nov;157(11):1905-16. doi: 10.1007/s00701-015-2578-2. Epub 2015 Sep 8.

Seizure outcomes in relation to the extent of resection of the perifocal fluorodeoxyglucose and flumazenil PET abnormalities in anteromedial temporal lobectomy.

Author information

1
Department of Neurosurgery Rikshospitalet, Oslo University Hospital, Sognsvannsveien 20, 0027, Oslo, Norway. mstanisi@ous-hf.no.
2
PET Core Facility/PET Centre, Oslo University Hospital, Oslo, Norway.
3
Department of Neurosurgery Rikshospitalet, Oslo University Hospital, Sognsvannsveien 20, 0027, Oslo, Norway.
4
Section of Nuclear Medicine & PET, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
5
Department of Radiology, Oslo University Hospital, Oslo, Norway.
6
Department of Clinical Psychology and Neuropsychology, National Center for Epilepsy, Oslo University Hospital, Oslo, Norway.
7
Department of Adult Epilepsy, National Center for Epilepsy, Oslo University Hospital, Oslo, Norway.
8
Department of Pathology, Oslo University Hospital, Oslo, Norway.
9
Oslo Center of Biostatistics and Epidemiology, Research Support Service, Oslo University Hospital, Oslo, Norway.
10
Clinical Neurophysiologic Laboratories, Department of Neurosurgery, Oslo University Hospital, Oslo, Norway.

Abstract

BACKGROUND:

The area of predominant perifocal [(18)F]fluorodeoxyglucose ((18)F-FDG) hypometabolism and reduced [(11)C]flumazenil ((11)C-FMZ) -binding on PET scans is currently considered to contain the epileptogenic zone and corresponds anatomically to the area localizing epileptogenicity in patients with temporal lobe epilepsy (TLE). The question is whether the volume of the perifocal pre-operative PET abnormalities, the extent of their resection, and the volume of the non-resected abnormalities affects the post-operative seizure outcome.

METHODS:

The sample group consisted of 32 patients with mesial temporal sclerosis who underwent anteromedial temporal lobe resection for refractory TLE. All patients had pathologic perifocal findings on both of the PET modalities as well as on the whole-brain MRI. The volumetric data of the PET and MRI abnormalities within the resected temporal lobe were estimated by automated quantitative voxel-based analysis. The obtained volumetric data were investigated in relation to the outcome subgroups of patients (Engel classification) determined at the 2-year post-operative follow-up.

RESULTS:

The mean volume of the pre-operative perifocal (18)F-FDG- and (11)C-FMZ PET abnormalities in the volumes of interest (VOI) of the epileptogenic temporal lobe, the mean resected volume of these PET abnormalities, the mean volume of the non-resected PET abnormalities, and the mean MRI-derived resected volume were not significantly related to the outcome subgroups and had a low prediction for individual freedom from seizures.

CONCLUSIONS:

The extent of pre-surgical perifocal PET abnormalities, the extent of their resection, and the extent of non-resected abnormalities were not useful predictors of individual freedom from seizures in patients with TLE.

KEYWORDS:

11C-FMZ-PET; 18F-FDG-PET; Post-operative outcome; Temporal lobe epilepsy

PMID:
26350516
PMCID:
PMC4604506
DOI:
10.1007/s00701-015-2578-2
[Indexed for MEDLINE]
Free PMC Article

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