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

Vinton, Anita B., Carne, Ross, Hicks, Rodney J., Desmond, Patricia M., Kilpatrick, Christine, Kaye, Andrew H. and O'Brien, Terence J. 2007, The extent of resection of FDG-PET hypometabolism relates to outcome of temporal lobectomy, Brain : a journal of neurology, vol. 130, no. 2, pp. 548-560, doi: 10.1093/brain/awl232.

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Title The extent of resection of FDG-PET hypometabolism relates to outcome of temporal lobectomy
Author(s) Vinton, Anita B.
Carne, Ross
Hicks, Rodney J.
Desmond, Patricia M.
Kilpatrick, Christine
Kaye, Andrew H.
O'Brien, Terence J.
Journal name Brain : a journal of neurology
Volume number 130
Issue number 2
Start page 548
End page 560
Total pages 13
Publisher Oxford University Press
Place of publication Oxford, England
Publication date 2007
ISSN 0006-8950
Summary 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.
Language eng
DOI 10.1093/brain/awl232
Field of Research 110323 Surgery
HERDC Research category C1.1 Refereed article in a scholarly journal
Copyright notice ©2006, The Authors
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Document type: Journal Article
Collection: School of Medicine
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