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Objective To introduce the technique of interictal 18F-fluorodeoxyglucose positron emission tomography (18F-FDG-PET) examination and explore the value of 18F-FDG-PET in the localization of epileptogenic focus of temporal lobe epilepsy (TLE) confirmed by surgical result.Methods Clinical data were retrospectively analyzed in 82 TLE patients having received interictal 18F-FDG-PET preoperative evaluation and got EngleⅠ grade epileptic surgical outcome, and the sensitivity and specialty of interictal 18F-FDG-PET were compared with those of MRI and scalp video-EEG. Results Epileptogenic foci showed hypometabolism on 18F-FDG-PET, and the hypometabolism zones were localized in ipsilateral temporal lobe in 68 cases,beyond ipsilateral temporal lobe in 9 cases; the other 5 had no hypometabolism zone. Accuracy rate of localization of epileptogenic foci by interictal 18F-FDG-PET was 82.9% (68/82), significantly higher than that by MRI or EEG(P＜0.05).77.4%(41/53)epileptogenic foci where MRI showed negative and 75%(15/20)where EEG with imbedded electrode was applied were precisely localized by 18F-FDG-PET. The accuracy was higher in the cases with positive pathological result than in the ones with negative result. Conclusions Interictal 18F-FDG-PET possesses excellent sensitivity and specialty in preopemtive assessment for TLE, and is of good value in the localization of epileptogenic focus where MRI shows negative or invasive electrophysiologic monitoring is needed.Rational application may raise the accuracy rate.
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Objective To explore the epileptogenic focus locating methods before and during operation and the curative effect of surgical treatment on the basis of localization. Methods Epileptogenic foci in 621 cases of intractable epilepsy were localized according to clinical manifestations and imaging findings by routine EEG (REEG), ambulatory EEG (AEEG) or video-EEG (VEEG).Different types of operations were performed based on the categories of epilepsy, the preoperatively localized foci and electrocorticogram (ECoG) monitoring results during operations. Results The follow-up ranging 0.5-4 years revealed, according to the criteria of International Antiepileptic Association,that 340 cases(54%)were completely recovered(no postoperative seizure),223 cases(36%)were improved obviously (seizure frequency was decreased by more than 75%), 37 cases (6%) were improved a little(seizure frequency was decreased by 50%-75%)and 21(3%)were not improved(seizure frequency was decreased by less than 50%): the effective rdte was 97%.No case worsened.Conclusions Preoperative integrated localization by EEG principally and intraoperative ECoG monitoring can effectively confirm the site and size of epileptogenic foci to instruct the operation and prevent complications so that the satisfactory treatment efficacy can be achieved.
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Objective To explore the surgical effect to traumatic tentorial herniation with bilater- al mydriasis.Methods The patients were divided into three groups,ie,epidural hematoma group,a- cute diffuse brain swelling group and cerebral contusion and/or subdural hematoma group,to perform clinical outcome analysis.Half year after operation,the neurological outcome was scored according to the Glasgow Outcome Scale.Results Of all,there were three cases with good recovery,10 with moderate disability,nine with severe disability and 10 with vegetative survival but 35 deaths.The outcome was the best in epidural hemotoma group but the poorest in acute diffuse brain swelling group.Conclusions The operative effect of traumatic cerebral herniation with bilateral mydriasis is related with the type of orig- inal injury that is important for selection of operation.Patients with cerebral herniation caused by epidural hematoma should receive immediate operation that will induce better outcome.The operation is not vital for those with cerebral herniation caused by acute diffuse brain swelling.Emergent surgery can save lives of some patients with cerebral contusion and/or subdural hematoma.Rapid diagnosis,correct operation and perioperative treatment may ensure the success of surgery.