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Anteromesial Temporal Lobectomy for Medically Intractable Temporal Lobe Epilepsy: An Operative Study
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Anteromesial Temporal Lobectomy for Medically Intractable Temporal Lobe Epilepsy: An Operative Study

Published on: August 15, 2025

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Surgical Treatment of Lesional Mesial Temporal Lobe Epilepsy

Sangjoon Chong1, Ji Hoon Phi1, Ji Yeoun Lee1,2

  • 1Division of Pediatric Neurosurgery, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea.

Journal of Epilepsy Research
|August 10, 2018
PubMed

Insights

Lesional mesial temporal lobe epilepsy (mTLE) surgery requires precise lesion identification. 11C-methionine PET aids in distinguishing tumors from focal cortical dysplasia (FCD) for tailored epilepsy treatment.

Area of Science:

  • Neurology
  • Neurosurgery
  • Medical Imaging

Background:

  • Lesional mesial temporal lobe epilepsy (mTLE) involves non-hippocampal sclerosis lesions in the temporal lobe.
  • Focal cortical dysplasia (FCD) and tumors are common causes of lesional mTLE, often requiring surgical intervention.
  • Differentiating between tumors and FCD, and determining surgical extent, can be challenging.

Purpose of the Study:

  • To evaluate the utility of 11C-methionine positron emission tomography (PET) in differentiating between tumors and FCD in lesional mTLE.
  • To inform surgical planning and treatment strategies for patients with lesional mTLE.

Main Methods:

  • Utilized 11C-methionine PET imaging to assess lesion uptake patterns in patients with lesional mTLE.
  • Reviewed surgical outcomes and histopathological findings in relation to imaging characteristics.
  • Considered surgical approaches like the transsylvian-transcisternal approach for accessing mesial temporal structures.

Main Results:

  • 11C-methionine PET demonstrated distinct uptake patterns: tumors showed high uptake ('hot'), while FCD did not.
  • Complete tumor excision is crucial for seizure control in tumorous mTLE.
  • Lesions in FCD may be larger than apparent on MRI, necessitating comprehensive epileptogenic focus localization, potentially including invasive studies.

Conclusions:

  • 11C-methionine PET is a valuable tool for pre-surgical differentiation of lesions in lesional mTLE.
  • Tailored surgical approaches based on lesion characteristics (tumor vs. FCD) are essential for optimizing seizure control and neurological function.
  • Accurate localization of epileptogenic foci is critical for successful FCD surgery.
Keywords:
Dysembryoplastic neuroepithelial tumorEpilepsyFocal cortical dysplasiaGangliogliomaLesionectomyMesial temporal lobe

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