Department of Neurology Neurosurgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
Epilepsia. 2012 Feb;53(2):342-8. doi: 10.1111/j.1528-1167.2011.03359.x. Epub 2011 Dec 22.
Fluorodeoxyglucose positron emission computed tomography (FDG-PET) hypometabolism is important for surgical planning in patients with temporal lobe epilepsy (TLE), but its significance remains unclear in patients who do not have evidence of mesial temporal sclerosis (MTS) on magnetic resonance imaging (MRI). We examined surgical outcomes in a group of PET-positive, MRI-negative patients and compared them with those of patients with MTS.
We queried the Thomas Jefferson University Surgical Epilepsy Database for patients who underwent anterior temporal lobectomy (ATL) from 1991 to 2009 and who had unilateral temporal PET hypometabolism without an epileptogenic lesion on MRI (PET+/MRI-). We compared this group to the group of patients who underwent ATL and who had MTS on MRI. Patients with discordant ictal electroencephalography (EEG) were excluded. Surgical outcomes were compared using percentages of Engel class I outcomes at 2 and 5 years as well as Kaplan-Meier survival statistic, with time to seizure recurrence as survival time. A subgroup of PET+/MRI- patients who underwent surgical implantation prior to resection was compared to PET+/MRI- patients who went directly to resection without implantation.
There were 46 PET+/MRI- patients (of whom 36 had 2-year surgical outcome available) and 147 MTS patients. There was no difference between the two groups with regard to history of febrile convulsions, generalized tonic-clonic seizures, interictal spikes, depression, or family history. Mean age at first seizure was higher in PET+/MRI- patients (19 ± 13 vs.14 ± 13 years, Mann-Whitney test, p = 0.008) and disease duration was shorter (14 ± 10 vs. 22 ± 13 years, student's t-test, p = 0.0006). Class I surgical outcomes did not differ significantly between the PET+/MRI- patients and the MTS group (2 and 5 year outcomes were 76% and 75% for the PET+/MRI- group, and 71% and 78% for the MTS group); neither did outcomes of the PET+/MRI- patients who were implanted prior to resection versus those who went directly to surgery (implanted patients had 71% and 67% class I outcomes at 2 and 5 years, whereas. nonimplanted patients had 77% and 78% class I outcomes, p = 0.66 and 0.28). Kaplan-Meier survival statistics for both comparisons were nonsignificant at 5 years. Dentate gyrus and hilar cell counts obtained from pathology for a sample of patients also did not differ between groups.
PET-positive, MRI-negative TLE patients in our study had excellent surgical outcomes after ATL, very similar to those in patients with MTS, regardless of whether or not they undergo intracranial monitoring. These patients should be considered prime candidates for ATL, and intracranial monitoring is probably unnecessary in the absence of discordant data.
氟脱氧葡萄糖正电子发射计算机断层扫描（FDG-PET）代谢低下对于颞叶癫痫（TLE）患者的手术规划很重要，但在磁共振成像（MRI）上没有证据显示内侧颞叶硬化（MTS）的患者中，其意义仍不清楚。我们研究了一组 PET 阳性、MRI 阴性患者的手术结果，并将其与 MTS 患者进行了比较。
我们查询了托马斯杰斐逊大学外科癫痫数据库，检索了 1991 年至 2009 年期间接受单侧前颞叶切除术（ATL）的患者，这些患者的 MRI 上没有致痫病变，但存在单侧颞叶 PET 代谢低下（PET+/MRI-）。我们将这组患者与 MRI 上有 MTS 的患者进行了比较。排除了癫痫发作的脑电图（EEG）不一致的患者。使用 2 年和 5 年的 Engel 分级 I 结果的百分比以及 Kaplan-Meier 生存统计来比较手术结果，以癫痫复发时间作为生存时间。我们还比较了一组 PET+/MRI-患者，他们在切除前进行了手术植入，与直接切除而没有植入的 PET+/MRI-患者进行了比较。
有 46 例 PET+/MRI-患者（其中 36 例有 2 年手术结果）和 147 例 MTS 患者。两组患者的热性惊厥史、全面强直阵挛性发作、间发性棘波、抑郁或家族史无差异。PET+/MRI-患者的首次癫痫发作年龄较高（19 ± 13 岁 vs. 14 ± 13 岁，Mann-Whitney 检验，p = 0.008），疾病持续时间较短（14 ± 10 岁 vs. 22 ± 13 岁，学生 t 检验，p = 0.0006）。PET+/MRI-患者与 MTS 组的 I 级手术结果无显著差异（PET+/MRI-组 2 年和 5 年的 I 级结果分别为 76%和 75%，MTS 组分别为 71%和 78%）；接受术前植入的 PET+/MRI-患者与直接手术的患者的结果也没有差异（植入患者的 2 年和 5 年 I 级结果分别为 71%和 67%，而非植入患者的 I 级结果分别为 77%和 78%，p = 0.66 和 0.28）。这两个比较的 Kaplan-Meier 生存统计在 5 年内均无显著性。从病理获得的齿状回和门细胞计数在两组之间也没有差异。
我们研究中的 PET 阳性、MRI 阴性 TLE 患者在接受 ATL 后手术结果非常好，与 MTS 患者非常相似，无论是否进行颅内监测。这些患者应该是 ATL 的首选候选人，在没有不一致数据的情况下，颅内监测可能是不必要的。
