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Preoperative FDG-PET temporal lobe hypometabolism and verbal memory after temporal lobectomy

From the Department of Psychology (H.R. Griffith and Dr. Seidenberg), Chicago Medical School, IL; the Departments of Radiology (Drs. Perlman and DeLaPena), Neurology (Drs. Woodard, Rutecki, Jones, and Hermann), and Neurosurgery (Dr. Ramirez), University of Wisconsin, Madison; and the Departments of Neurology (Drs. Rutecki and Jones) and Neurosurgery (Dr. Ramirez), William S. Middleton VA Hospital, Madison, WI.

Address correspondence and reprint requests to Dr. Bruce Hermann, Department of Neurology, University of Wisconsin, 600 N. Highland, Madison, WI 53792; e-mail: hermann{at}neurology.wisc.edu

OBJECTIVE: To examine the relationship of preoperative fluorodeoxyglucose (FDG)-PET asymmetry in temporal lobe metabolism and memory outcome after anterior temporal lobectomy (ATL).

METHODS: In a university-based epilepsy surgery center, 60 ATL patients (27 left, 33 right) were divided into two groups: no/mild (n = 21) or moderate/severe (n = 39) asymmetry in temporal lobe hypometabolism as determined by FDG-PET. All patients were nonretarded, at least 18 years of age, left-hemisphere speech dominant, without MRI abnormalities other than hippocampal atrophy, and with unilateral temporal lobe origin of intractable complex partial seizures. Neuropsychological measures of intelligence and verbal and visual memory function were assessed preoperatively and 6 months postoperatively.

RESULTS: Left ATL patients with no/mild asymmetry in FDG-PET temporal lobe metabolism exhibited significantly greater verbal memory decline compared with left ATL patients with moderate/severe hypometabolism. There was no significant relationship between PET asymmetry and pre- to postsurgical IQ change. No significant relationship was observed between extent of PET hypometabolism and memory outcome for right ATL patients.

CONCLUSIONS: FDG-PET asymmetry can be added to the preoperative clinical markers that appear useful in predicting verbal memory decline after left ATL.

Key words: PET—Epilepsy surgery—Neuropsychology—Memory—Anterior temporal lobectomy.

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