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Updated: Apr 10, 2026
Anteromesial Temporal Lobectomy for Medically Intractable Temporal Lobe Epilepsy: An Operative Study
Published on: August 15, 2025
Surgical outcome in patients with MRI-negative, PET-positive temporal lobe epilepsy
Irem Yıldırım Capraz1, Gökhan Kurt2, Özgür Akdemir3
1Gazi University, Faculty of Medicine, Department of Neurology, Ankara, Turkey.
Purpose:
The purpose of this study was to determine the long-term surgical outcomes of magnetic resonance imaging (MRI)-negative, fluorodeoxyglucose positron emission tomography (FDG-PET)-positive patients with temporal lobe epilepsy (TLE) and compare them with those of patients with mesial temporal sclerosis (MTS).
Methods:
One hundred forty-one patients with TLE who underwent anterior temporal lobectomy were included in the study. The surgical outcomes of 24 patients with unilateral temporal hypometabolism on FDG-PET without an epileptogenic lesion on MRI were compared with that of patients with unilateral temporal hypometabolism on FDG-PET with MTS on MRI (n=117). The outcomes were compared using Engel's classification at 2 years after surgery. Clinical characteristics, unilateral interictal epileptiform discharges (IEDs), histopathological data and operation side were considered as probable prognostic factors.
Results:
Class I surgical outcomes were similar in MRI-negative patients and the patients with MTS on MRI (seizure-free rate at postoperative 2 years was 79.2% and 82% in the MRI-negative and MTS groups, respectively). In univariate analysis, history of febrile convulsions, presence of unilateral IEDs and left temporal localization were found to be significantly associated with seizure free outcome. Multivariate analysis revealed that independent predictors of a good outcome were history of febrile convulsions and presence of unilateral IEDs.
Conclusion:
Our results suggest that epilepsy surgery outcomes of MRI-negative, PET positive patients are similar to those of patients with MTS. This finding may aid in the selection of best candidates for epilepsy surgery.
Insights
Epilepsy surgery outcomes are similar for patients with MRI-negative, FDG-PET-positive temporal lobe epilepsy (TLE) and those with mesial temporal sclerosis (MTS). This finding helps identify optimal surgical candidates for TLE.
Area of Science:
- Neurosurgery
- Epileptology
- Medical Imaging
Background:
- Temporal Lobe Epilepsy (TLE) is a common focal epilepsy.
- Identifying optimal surgical candidates is crucial for improving patient outcomes.
- Magnetic Resonance Imaging (MRI) negative cases pose diagnostic challenges.
Purpose of the Study:
- To determine long-term surgical outcomes in MRI-negative, FDG-PET-positive TLE patients.
- To compare these outcomes with patients diagnosed with mesial temporal sclerosis (MTS).
- To identify prognostic factors for successful epilepsy surgery.
Main Methods:
- Anterior temporal lobectomy was performed on 141 TLE patients.
- Compared outcomes of 24 MRI-negative, FDG-PET-positive patients with 117 MTS patients.
- Outcomes assessed using Engel's classification at 2 years post-surgery.
Main Results:
- Class I surgical outcomes were comparable: 79.2% seizure-free in MRI-negative vs. 82% in MTS group.
- Univariate analysis identified febrile convulsions, unilateral IEDs, and left temporal localization as significant factors.
- Multivariate analysis confirmed history of febrile convulsions and unilateral IEDs as independent predictors of good outcomes.
Conclusions:
- Epilepsy surgery yields similar outcomes for MRI-negative, PET-positive TLE patients and those with MTS.
- These findings support considering MRI-negative, PET-positive individuals as suitable candidates for epilepsy surgery.
- This research aids in refining patient selection for improved surgical success rates in TLE.
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