Positron Emission Tomography (PET) in Predicting Postoperative Outcomes in Anterior Temporal Lobectomy

Introduction: Temporal Lobe Epilepsy (TLE) remains one of the most prevalent and challenging neurological disorders in modern medicine. PET, with its precise imaging capabilities, emerges as a pivotal tool. This review underscores the transformative role of PET in reshaping the surgical paradigms, especially for patients undergoing Anterior Temporal Lobectomy (ATL) as a therapeutic intervention for TLE.

Methods: A systematic review was conducted following PRISMA guidelines using PubMed, SCOPUS, and ScienceDirect (1985-2022). Search terms included "positron emission tomography", "temporal lobe epilepsy", and "anterior temporal lobectomy". Of the 169 initial results, 52 articles were deemed eligible after thorough screening. Inclusion criteria focused on PET imaging's role in localizing seizure foci and predicting outcomes post-ATL for TLE patients. Studies involving pediatric patients, animals, and non-clinical reports were excluded. Data extraction was handled by two independent reviewers, and quality assessment was done using the Newcastle-Ottawa Scale. Descriptive analysis summarized study characteristics, outcomes, and potential biases.

Results: Our analysis revealed that FDG-PET imaging was instrumental in identifying seizure foci and predicting postoperative results. It exhibited significant value in situations where structural abnormalities were absent on MRI scans. Furthermore, newer radiotracers such as 5-HT1A antagonists, FCWAY and MPPF, presented promising potential for localizing seizure foci, particularly in MRI-negative TLE, despite their comparatively limited current usage.

Conclusion : PET imaging, although challenged by issues such as radiation exposure, limited accessibility, and high costs, offers considerable promise. Integration with other imaging modalities, such as EEG and MRI, has contributed to improved localization of epileptogenic foci and subsequently, enhanced surgical outcomes. Further research must focus on establishing the relative efficacy and optimal combinations of these radiotracers in the orchestration of ATL surgical planning and prognostication of postoperative outcomes for TLE patients. Encouragingly, these advancements hold the potential to revolutionize the management of TLE, delivering a better quality of life for patients.