Comparing propofol versus sevoflurane anesthesia for epileptogenic focus detection during positron emission tomography in pediatric patients.

Background. Fluoro-D-deoxyglucose positron emission tomography (FDG-PET) is a standard procedure for interictal assessment and accurate pre-surgical evaluation of presumed epileptogenic zone localization. Profound sedation or general anesthesia is frequently required to reduce movement artefacts in young or cognitively impaired patients during image acquisition. This study compares the impact of propofol and sevoflurane anesthesia on overall quality of PET images, detectability of a hypometabolic lesion and demarcation of the detected lesion in pediatric patients suffering from focal epilepsia. Methods. Pediatric patients with focal epilepsia were anesthesized using propofol (N.=37) or sevoflurane (N.=43). Two independent blinded investigators rated the PET-scans on a 3-point Likert scale with respect to overall quality of PET images, detectability of a hypometabolic lesion and demarcation of the detected lesion. Mann-Whitney-U-Test was conducted to compare the rating results between the two anesthesia regimes. Inter-rater reliability was calculated using Cohen's Kappa. Results. Anesthesia was throughout uneventful and there was no clinical evidence for peridiagnostic seizures. Differences in neither single dimension ratings nor in sum scores (mean 5.8 +/- SD 1.5 for propofol, and 5.7 +/- SD 1.5 for sevoflurane; P=0.567) were statistically significant. Cohen's Kappa was between 0.428 and 0.499. Conclusion. For surgical planning in patients with epilepsy, FDG-PET imaging is an indispensable functional imaging technique to detect hypometabolism. We conclude that both, sevoflurane and propofol based anesthetic regimes are suitable to detect hypometabolic cerebral lesions during FDG-PET.