Posterior Cortex Deafferentation Following Surgical Disconnection Revealed by 18 F-FDG PET/MRI Fusion

Area of Science:

• Pediatric Neurology
• Neurosurgery
• Neuroimaging

Background:

• Epileptic encephalopathy can progress to severe syndromes like Lennox-Gastaut syndrome.
• Lennox-Gastaut syndrome presents with debilitating seizures, including drop attacks and behavioral arrest.
• Cystic lesions near the ventricle can cause neurological deficits.

Purpose of the Study:

• To report a case of Lennox-Gastaut syndrome secondary to a rare ependymal cyst.
• To describe the surgical and imaging findings of a lesionectomy for this condition.

Main Methods:

• Surgical removal (lesionectomy) of a cystic lesion.
• Parieto-occipital disconnection and posterior callosotomy.
• Postoperative Positron Emission Tomography/Magnetic Resonance Imaging (PET/MRI) for metabolic assessment.

Main Results:

• An ependymal cyst, a benign neuroepithelial lesion, was identified.
• Postoperative PET/MRI showed no metabolic activity in the affected brain regions.
• This indicated a deafferented cortex following the surgical intervention.

Conclusions:

• Surgical resection of ependymal cysts is a viable treatment option for associated neurological conditions.
• PET/MRI is effective in confirming the success of lesion removal and assessing cortical deafferentation.
• This case highlights a rare cause of epileptic encephalopathy and its successful management.