# The intraoperative SEEG and 18FDG-PET tailored temporal lobe resection (iSP-TR) for the tissue-spearing surgical treatment of drug-resistant mesial temporal lobe epilepsy: how we do it

## TL;DR

A new surgical method for treating drug-resistant epilepsy aims to remove less brain tissue while maintaining good seizure outcomes.

## Contribution

The iSP-TR method combines iSEEG and 18FDG-PET to guide surgery and spare brain tissue.

## Key findings

- iSP-TR spares brain parenchyma compared to traditional temporal lobectomy.
- Seizure outcomes are not compromised with the iSP-TR approach.
- nTMS is used to avoid functional cortical areas during surgery.

## Abstract

For drug-resistant mesial temporal lobe epilepsy (MTLE), surgery is recommended. There is no evidence of a seizure outcome advantage of temporal lobectomy over other strategies despite the high risks of this surgical procedure.

We describe a Temporal Resection guided by intraoperative stereo-electroencephalography (iSEEG) and the 18FluoroDeoxyGlucose PET (18FDG PET) (iSP-TR) to treat lesional MTLE. We avoided functional cortical areas using navigated Transcranial Magnetic Stimulation (nTMS).

iSP-TR allows for a spare brain parenchyma compared to temporal lobectomy without compromising seizure outcomes.

The online version contains supplementary material available at 10.1007/s00701-025-06491-x.