Abstract：
OBJECTIVE: Surgery is a good treatment option for drug-resistant temporal lobe epilepsy (TLE). 2-deoxy-2-(18F) fluoro-D-glucose (FDG) positron emission tomography (PET) is used to detect epileptic foci as hypometabolic lesions in presurgical evaluation. Visual field defects (VFDs) in the contralateral homonymous upper quadrant are common postoperative complications in TLE. This study aimed to quantify VFDs using pattern deviation probability plots (PDPPs) and examine the effect of hypometabolism in FDG-PET on VFDs.
METHODS: This study included 40 patients. Both visual fields were assessed using the Humphrey field analyzer preoperatively and 3 months and 2 years postoperatively. PDPPs with <0.5% confidence level counted in the contralateral homonymous upper quadrant. FDG-PET results were compared between groups with (15 patients) and without (24 patients) hypometabolism in the optic radiation.
RESULTS: All 40 patients were evaluated by Humphrey field analyzer at 3 months postoperatively and 39 at 2 years postoperatively. The incidence of VFDs 3 months postoperatively was 35/40 (87.5%), and 17/40 (42.5%) patients had severe VFDs. In cases of surgery on the left temporal lobe, ipsilateral eyes appeared to be more significantly affected than contralateral eyes. VFDs were more severe in patients with FDG hypometabolism than in those without hypometabolism in posteromedial temporal and medial occipital cortex (P < 0.01); however, 85% of patients with FDG hypometabolism had a reduced VFD 2 years postoperatively.
CONCLUSIONS: PDPP counting is useful for quantifying VFDs. Preoperative dysfunction indicated by preoperative FDG-PET in the posteromedial temporal and medial occipital cortex could enhance VFDs early after TLE surgery.
METHODS: This study included 40 patients. Both visual fields were assessed using the Humphrey field analyzer preoperatively and 3 months and 2 years postoperatively. PDPPs with <0.5% confidence level counted in the contralateral homonymous upper quadrant. FDG-PET results were compared between groups with (15 patients) and without (24 patients) hypometabolism in the optic radiation.
RESULTS: All 40 patients were evaluated by Humphrey field analyzer at 3 months postoperatively and 39 at 2 years postoperatively. The incidence of VFDs 3 months postoperatively was 35/40 (87.5%), and 17/40 (42.5%) patients had severe VFDs. In cases of surgery on the left temporal lobe, ipsilateral eyes appeared to be more significantly affected than contralateral eyes. VFDs were more severe in patients with FDG hypometabolism than in those without hypometabolism in posteromedial temporal and medial occipital cortex (P < 0.01); however, 85% of patients with FDG hypometabolism had a reduced VFD 2 years postoperatively.
CONCLUSIONS: PDPP counting is useful for quantifying VFDs. Preoperative dysfunction indicated by preoperative FDG-PET in the posteromedial temporal and medial occipital cortex could enhance VFDs early after TLE surgery.
摘要：
目的：手术是耐药性颞叶癫痫（TLE）的良好治疗选择。2-脱氧-2-（18F）氟-D-葡萄糖（FDG）正电子发射断层扫描（PET）用于在术前评估中将癫痫灶检测为低代谢病变。对侧同义上象限的视野缺损（VFD）是TLE术后常见的并发症。本研究旨在使用模式偏差概率图（PDPPs）对VFD进行量化，并研究FDG-PET中的低代谢对VFD的影响。
方法：本研究包括40名患者。术前和术后3个月和2年使用Humphrey场分析仪（HFA）评估两个视野。在对侧同义上象限计数具有<0.5%置信水平的PDPPs。比较了有（15例）和没有（24例）视神经辐射低代谢的组之间的FDG-PET结果。
结果：所有40例患者在术后3个月进行HFA评估，39例患者在术后2年进行评估。术后3个月VFD发生率为35/40(87.5%),17/40（42.5%）患者有严重的VFD。在左颞叶手术的情况下，同侧眼睛似乎比对侧眼睛受到更明显的影响。FDG低代谢患者的VFDs比后内侧颞叶和枕叶皮质无低代谢患者的VFDs更为严重(P<0.01);85%的FDG低代谢患者术后2年VFD减少。
结论：PDPP计数可用于定量VFD。术前FDG-PET显示的颞内侧和枕内侧皮质的术前功能障碍可在TLE手术后早期增强VFDs。
方法：本研究包括40名患者。术前和术后3个月和2年使用Humphrey场分析仪（HFA）评估两个视野。在对侧同义上象限计数具有<0.5%置信水平的PDPPs。比较了有（15例）和没有（24例）视神经辐射低代谢的组之间的FDG-PET结果。
结果：所有40例患者在术后3个月进行HFA评估，39例患者在术后2年进行评估。术后3个月VFD发生率为35/40(87.5%),17/40（42.5%）患者有严重的VFD。在左颞叶手术的情况下，同侧眼睛似乎比对侧眼睛受到更明显的影响。FDG低代谢患者的VFDs比后内侧颞叶和枕叶皮质无低代谢患者的VFDs更为严重(P<0.01);85%的FDG低代谢患者术后2年VFD减少。
结论：PDPP计数可用于定量VFD。术前FDG-PET显示的颞内侧和枕内侧皮质的术前功能障碍可在TLE手术后早期增强VFDs。
