Different effects of anterior temporal lobectomy and selective amygdalohippocampectomy on verbal memory performance of patients with epilepsy

Abstract BACKGROUND Mesiotemporal lobe epilepsy is one of the most frequent causes for pharmacoresistant epilepsy. Different surgical approaches to the mesiotemporal area are used. OBJECTIVE To analyze epileptological and neuropsychological results as well as complications of different surgical strategies. METHODS This retrospective study is based on a consecutive series of 458 patients all harboring pharmacoresistant mesiotemporal lobe epilepsy. Following procedures were performed: standard anterior temporal lobectomy, anterior temporal or key-hole resection, extended lesionectomy, and transsylvian and subtemporal selective amygdalohippocampectomy. Postoperative outcome was evaluated according to different surgical procedures. RESULTS Overall, 1 yr after surgery 315 of 432 patients (72.9%) were classified Engel I; in particular, 72.8% were seizure-free after anterior temporal lobectomy, 76.9% after key-hole resection, 84.4% after extended lesionectomy, 70.3% after transylvian selective amygdalohippocampectomy, and 59.1% after subtemporal selective amygdalohippocampectomy. No significant differences in seizure outcome were found between different resective procedures, neither in short-term nor long-term follow-up. There was no perioperative mortality. Permanent morbidity was encountered in 4.4%. There were no significant differences in complications between different resection types. In the majority of patients, selective attention improved following surgery. Patients after left-sided operations performed significantly worse regarding verbal memory as compared to right-sided procedures. However, surgical approach had no significant effect on memory outcome. CONCLUSION Different surgical approaches for mesiotemporal epilepsy analyzed resulted in similar epileptological, neuropsychological results, and complication rates. Therefore, the approach for the individual patient does not only depend on the specific localization of the epileptogenic area, but also on the experience of the surgeon.

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Selective Amygdalohippocampectomy: Indications and Follow-up

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/s0317167100032832 ◽

1991 ◽

Vol 18 (S4) ◽

pp. 617-627 ◽

Cited By ~ 33

Author(s):

Heinz Gregor Wieser

Keyword(s):

Surgical Treatment ◽

Small Proportion ◽

A Priori ◽

Temporal Lobectomy ◽

Anterior Temporal Lobectomy ◽

Surgical Interventions ◽

Selective Amygdalohippocampectomy ◽

Patients With Epilepsy ◽

Real Chance

ABSTRACT:Selective amygdalohippocampectomy (AHE) offers a real chance of cure only in patients with welldefined, precisely localized “epileptogenic area”, i.e. seizure focus. Therefore, a priori only a small proportion of all patients with epilepsy can meet the criteria for selective surgical interventions. From the evidence in patients meeting the criteria for AHE, we conclude that this technique is to be preferred to the “standard” anterior temporal lobectomy and represents a more selective but still effective surgical treatment of epilepsy.

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Memory for Faces and Paired Associates After Temporal Lobectomy in Childhood

Brain Impairment ◽

10.1375/brim.3.2.122 ◽

2002 ◽

Vol 3 (2) ◽

pp. 122-131

Author(s):

Andrew G. Rothwell ◽

Alan Tucker

Keyword(s):

Verbal Memory ◽

Memory Performance ◽

Temporal Lobectomy ◽

Anterior Temporal Lobectomy ◽

Delayed Recall ◽

Memory Decline ◽

Immediate Memory ◽

Paired Associates ◽

Post Surgery

AbstractFindings are reported from the first examination of the Beardsworth Memory for Children's Faces Test (BMCFT) (Beardsworth & Zaidel, 1994) tested on a selected sample of 10 left (LATL) and 7 right (RATL) anterior temporal lobectomy patients an average of 7 years post surgery. No differences between LATL and RATL groups were found on immediate or delayed memory trials of the BMCFT. Verbal memory was assessed with a verbal analogue of this test, the Extended Verbal Paired Associates Test (EVPAT) specifically constructed for this study. Differences were obtained on the immediate (F = 5.17; p < .01) and delayed (F = 6.55; p < .01) memory trials of the EVPAT with LATL patients learning and retrieving fewer verbal associations than their right ATL counterparts. No differences were found on the memory decline to delayed recall scores on the EVPAT. The findings suggest that people who have left or right ATL in childhood cannot be distinguished on the basis of their immediate or delayed memory for paired faces an average of 7 years post-surgery. These results are consistent with the immediate memory performance of children 6 months post-surgery as reported by Beardsworth and Zaidel (1994), but are not consonant with the delayed memory performance of their children on this task. This indicates that left-right dissociations found in children on measures of delayed memory for faces 6 months post-surgery may represent a component of memory that is still in a state of recovery. The findings for the immediate memory trials of the EVPAT conformed to expectations and underscore the dependability of simple rote verbal memory tasks in dissociating left from right ATL 7 years post-surgery. The study addresses the issue of the recovery of immediate versus delayed memory and time of assessment post-surgery.

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Anterior temporal lobectomy versus selective amygdalohippocampectomy in patients with mesial temporal lobe epilepsy

Arquivos de Neuro-Psiquiatria ◽

10.1590/0004-282x20150188 ◽

2015 ◽

Vol 74 (1) ◽

pp. 35-43 ◽

Cited By ~ 12

Author(s):

Fábio A. Nascimento ◽

Luana Antunes Maranha Gatto ◽

Carlos Silvado ◽

Maria Joana Mäder-Joaquim ◽

Marlus Sidney Moro ◽

...

Keyword(s):

Temporal Lobe Epilepsy ◽

Temporal Lobe ◽

Mesial Temporal Lobe Epilepsy ◽

Temporal Lobectomy ◽

Mesial Temporal Sclerosis ◽

Anterior Temporal Lobectomy ◽

Selective Amygdalohippocampectomy ◽

Significant Difference ◽

Mesial Temporal Lobe ◽

Neuropsychological Outcomes

ABSTRACT Objective To contribute our experience with surgical treatment of patients with mesial temporal lobe epilepsy (mTLE) undergoing anterior temporal lobectomy (ATL) or selective amygdalohippocampectomy (SelAH). Method This is a retrospective observational study. The sample included patients with medically refractory mTLE due to unilateral mesial temporal sclerosis who underwent either ATL or SelAH, at Hospital de Clinicas – UFPR, from 2005 to 2012. We report seizure outcomes, using Engel classification, cognitive outcomes, using measurements of verbal and visuospatial memories, as well as operative complications. Result Sixty-seven patients (33 ATL, 34 SelAH) were studied; median follow-up was 64 months. There was no statistically significant difference in seizure or neuropsychological outcomes, although verbal memory was more negatively affected in ATL operations on patients’ dominant hemispheres. Higher number of major complications was observed in the ATL group (p = 0.004). Conclusion Seizure and neuropsychological outcomes did not differ. ATL appeared to be associated with higher risk of complications.

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Predicting verbal memory decline following anterior temporal lobectomy (ATL)

Neurology ◽

10.1212/01.wnl.0000058765.33878.0d ◽

2003 ◽

Vol 60 (8) ◽

pp. 1266-1273 ◽

Cited By ~ 160

Author(s):

E. Stroup ◽

J. Langfitt ◽

M. Berg ◽

M. McDermott ◽

W. Pilcher ◽

...

Keyword(s):

Verbal Memory ◽

Temporal Lobectomy ◽

Anterior Temporal Lobectomy ◽

Memory Decline

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A-250 Evidence for Language and Memory Improvements Following Right Anterior Temporal Lobectomy in a Patient with Mixed Language Dominance

Archives of Clinical Neuropsychology ◽

10.1093/arclin/acaa068.250 ◽

2020 ◽

Vol 35 (6) ◽

pp. 1045-1045

Author(s):

Leonard S ◽

Olsen E ◽

Bradbury K

Keyword(s):

Verbal Memory ◽

Verbal Fluency ◽

Verbal Learning ◽

Temporal Lobectomy ◽

Neuropsychological Evaluation ◽

Language Abilities ◽

Anterior Temporal Lobectomy ◽

Language Dominance ◽

Mixed Language ◽

History Of

Abstract Objective Anterior temporal lobectomy (ATL) surgery for epilepsy is commonly associated with post-surgical impairments in memory and language abilities, specifically episodic memory and confrontational naming. Less is known regarding outcomes of patients with atypical language dominance. Method Casey is a 19 year-old, ambidextrous, male with a history of remote symptomatic medically intractable focal epilepsy secondary to right inferior temporal encephalomalacia. Casey underwent right anterior temporal lobectomy and resection of mesial structures including part of the hippocampus. Results Casey’s pre-surgical neuropsychological evaluation revealed overall intellectual functioning in the average range with relative strengths in perceptual reasoning skills and weaknesses in attention, executive control, confrontational naming, and verbal fluency. Casey’s pre-surgical cognitive profile and functional MRI were suggestive of bilateral language organization. At post-surgical evaluation, Casey demonstrated strong overall cognitive abilities, basic reading, visual–spatial skills, and visual memory, as well as notable improvements in his processing speed and visual-motor integration. He demonstrated significant improvement in verbal working memory, verbal fluency, and contextual verbal memory. Casey continued to show significant weaknesses in word finding, phonetic verbal fluency, and rote verbal learning and memory, and milder weaknesses in aspects of executive functioning. Casey continued to demonstrate mood difficulties. Conclusions The current case provides evidence of continued mild deficits in traditional dominant hemisphere skills including rote verbal memory and focal language abilities, in a patient with a history of mixed language dominance, following right hemisphere ATL surgery. This case further highlights the importance of pre-surgical neuropsychological evaluation and fMRI in patients undergoing right ATL surgery.

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A-080 Prediction Model for Verbal Memory Decline in Different Epilepsy Surgery Procedures: Temporal Lobectomy vs. Amygdalohippocampectomy

Archives of Clinical Neuropsychology ◽

10.1093/arclin/acaa068.080 ◽

2020 ◽

Vol 35 (6) ◽

pp. 872-872

Author(s):

Hageboutros K ◽

Bono A ◽

Johnson-Markve B ◽

Smith K ◽

Lee G

Keyword(s):

Prediction Model ◽

Epilepsy Surgery ◽

Verbal Memory ◽

Memory Loss ◽

Low Risk ◽

Temporal Lobectomy ◽

Moderate Risk ◽

Memory Decline ◽

Selective Amygdalohippocampectomy ◽

Risk Patients

Abstract Objective Mathematical models predicting risk of verbal memory decline after resective epilepsy surgery have been developed for patients undergoing temporal lobectomies. This study was undertaken to determine if application of the Stroup memory loss prediction model was as accurate in foreseeing verbal memory decline after temporal lobectomy as in the less invasive selective amygdalohippocampectomy procedure. Method This retrospective study examined the verbal memory performances of 40 left temporal lobectomy (ATL), and 16 left subtemporal approach selective amygdalohippocampectomy (SA-H), patients before and after epilepsy surgery using word list learning (Rey Auditory-Verbal Learning Test, Buschke Selective Reminding Test) and story memory (WMS Logical Memory) tests. Patients were assigned to one of four groups using the Stroup multiple regression equation: Minimal Risk (61% risk). To classify memory decline in individual patients, a pre-to-post surgery decrease of > 1 SD on at least one memory test constituted memory decline. Results The prediction model accurately classified 82% (9/11) of ATL, and 75% (3/4) of SA-H, High Risk patients. Verbal memory loss was higher among ATLs than SA-Hs in the Moderate Risk (87% vs. 18%) and Low Risk (71% vs. 0%) groups. Conclusion The Stroup verbal memory loss risk model under-predicted memory loss among temporal lobectomy patients (71% of Low Risk patients showed memory decline) and over-predicted memory loss among selective amygdalohippocampectomy patients (only 18% of Moderate Risk patients showed memory decline). Results should be considered preliminary due to methodological limitation including small Ns and unequal sample sizes.

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Wada memory performance predicts seizure outcome following anterior temporal lobectomy

Neurology ◽

10.1212/wnl.44.12.2322 ◽

1994 ◽

Vol 44 (12) ◽

pp. 2322-2322 ◽

Cited By ~ 74

Author(s):

D. W. Loring ◽

K. J. Meador ◽

G. P. Lee ◽

M. E. Nichols ◽

D. W. King ◽

...

Keyword(s):

Memory Performance ◽

Temporal Lobectomy ◽

Seizure Outcome ◽

Anterior Temporal Lobectomy

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Seizure and memory outcome following temporal lobe surgery: selective compared with nonselective approaches for hippocampal sclerosis

Journal of Neurosurgery ◽

10.3171/jns.2006.104.1.70 ◽

2006 ◽

Vol 104 (1) ◽

pp. 70-78 ◽

Cited By ~ 108

Author(s):

Eliseu Paglioli ◽

André Palmini ◽

Mirna Portuguez ◽

Eduardo Paglioli ◽

Ney Azambuja ◽

...

Keyword(s):

Temporal Lobe ◽

Verbal Memory ◽

Seizure Control ◽

Hippocampal Sclerosis ◽

Surgical Techniques ◽

Mesial Temporal Lobe Epilepsy ◽

Outcome Data ◽

Temporal Lobectomy ◽

Selective Amygdalohippocampectomy

Object The aim of this study was to compare seizure and memory outcome in patients with medically refractory mesial temporal lobe epilepsy due to hippocampal sclerosis (MTLE/HS) treated using an anterior temporal lobectomy (ATL) or a selective amygdalohippocampectomy (SA). Methods Surgical outcome data were prospectively collected for 2 to 11 years in 161 consecutive patients with MTLE/HS. Eighty patients underwent an ATL and 81 an SA. Seizure control achieved with each technique was compared using the Engel classification scheme. Postoperative memory testing was performed in 86 patients (53%). At the last follow up, 72% of the patients who had undergone an ATL (mean follow up 6.7 years) and 71% of those who had undergone an SA (mean follow up 4.5 years) were seizure free (Engle Class IA). Estimated survival in patients in Engel Classes I, IA, and I and II combined did not differ between the two surgical techniques. Preoperatively, 58% of the patients had verbal memory scores one standard deviation (SD) below the normal mean. One third of the patients with preoperative scores in the normal range worsened after surgery, although this outcome was not related to the surgical technique. In contrast, one third of those whose preoperative scores were less than −1 SD experienced improvement after surgery. Nine (18%) of the 50 patients whose left side had been surgically treated improved their verbal memory scores by more than one SD. Seven (78%) of these nine underwent an SA (p = 0.05). Conclusions Both ATL and SA can lead to similar favorable seizure control in patients with MTLE/HS. Preliminary data suggest that postoperative verbal memory scores may improve in patients who undergo selective resection of a sclerotic hippocampus in the dominant temporal lobe.

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