Verbal learning and memory outcome in selective amygdalohippocampectomy versus temporal lobe resection in patients with hippocampal sclerosis

The differential contribution of medial-temporal lobe regions to verbal declarative memory is debated within the neuroscience, neuropsychology, and cognitive psychology communities. We evaluate whether the extent of surgical resection within medial-temporal regions predicts longitudinal verbal learning and memory outcomes. This single-center retrospective observational study involved patients with refractory temporal lobe epilepsy undergoing unilateral anterior temporal lobe resection from 2007 to 2015. Thirty-two participants with Engel Class 1 and 2 outcomes were included (14 left, 18 right) and followed for a mean of 2.3 years after surgery (±1.5 years). Participants had baseline and postsurgical neuropsychological testing and high-resolution T1-weighted MRI scans. Postsurgical lesions were manually traced and coregistered to presurgical scans to precisely quantify resection extent of medial-temporal regions. Verbal learning and memory change scores were regressed on hippocampal, entorhinal, and parahippocampal resection volume after accounting for baseline performance. Overall, there were no significant differences in learning and memory change between patients who received left and right anterior temporal lobe resection. After controlling for baseline performance, the extent of left parahippocampal resection accounted for 27% (p = .021) of the variance in verbal short delay free recall. The extent of left entorhinal resection accounted for 37% (p = .004) of the variance in verbal short delay free recall. Our findings highlight the critical role that the left parahippocampal and entorhinal regions play in recall for verbal material.

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Neuropsychological performance and seizure control after subsequent anteromesial temporal lobe resection following selective amygdalohippocampectomy

Epilepsia ◽

10.1111/epi.13567 ◽

2016 ◽

Vol 57 (11) ◽

pp. 1789-1797 ◽

Cited By ~ 3

Author(s):

Thomas Sauvigny ◽

Katja Brückner ◽

Lasse Dührsen ◽

Oliver Heese ◽

Manfred Westphal ◽

...

Keyword(s):

Temporal Lobe ◽

Seizure Control ◽

Neuropsychological Performance ◽

Selective Amygdalohippocampectomy ◽

Temporal Lobe Resection

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VISUAL FIELD DEFECTS IN SELECTIVE AMYGDALOHIPPOCAMPECTOMY FOR HIPPOCAMPAL SCLEROSIS

Neurosurgery ◽

10.1227/01.neu.0000324895.19708.68 ◽

2008 ◽

Vol 63 (3) ◽

pp. 507-515 ◽

Cited By ~ 30

Author(s):

S. Naz Yeni ◽

Necmettin Tanriover ◽

Özlem Uyanik ◽

Mustafa Onur Ulu ◽

Çiğdem Özkara ◽

...

Keyword(s):

Visual Field ◽

Temporal Lobe Epilepsy ◽

Temporal Lobe ◽

Epilepsy Surgery ◽

Hippocampal Sclerosis ◽

Visual Field Defects ◽

Selective Amygdalohippocampectomy ◽

Temporal Horn ◽

Visual Field Deficits ◽

Meyer’S Loop

ABSTRACT OBJECTIVE Meyer's loop, the most vulnerable part of the optic radiations during approaches to the temporomedial region, extends to the tip of the temporal horn and is often encountered in epilepsy surgery. The risk of damaging Meyer's loop during transsylvian selective amygdalohippocampectomy peaks while accessing the temporal horn through its roof by opening the inferior limiting sulcus of the insula. In this prospective study, we sought to evaluate and identify the incidence of visual field deficits in a homogeneous group of patients who had temporal lobe epilepsy with hippocampal sclerosis and who underwent transsylvian selective amygdalohippocampectomy. METHODS We studied 30 patients who were referred for epilepsy surgery for intractable complex partial and/or secondary generalized seizures and evaluated according to a noninvasive protocol. All patients underwent selective amygdalohippocampectomy for temporal lobe epilepsy with hippocampal sclerosis using the standard transsylvian approach. Visual field deficits were examined preoperatively in 30 patients, by either a confrontation method (n = 18) or standard Goldmann perimetry (n = 12) and postoperatively in all patients using standard Humphrey digital perimetry. RESULTS Visual field examination was normal in all patients before surgery. Humphrey perimetric measurement revealed visual field deficits in 11 patients (36.6%) after surgery. CONCLUSION We have shown that there is a considerable risk of having visual field deficits after standard transsylvian selective amygdalohippocampectomy owing to the interruption of the anterior bundle of the optic radiation fibers, which most likely occurs while opening the temporal horn through the inferior limiting sulcus of the insula.

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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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Presence of Temporal Gray-White Matter Abnormalities Does Not Influence Epilepsy Surgery Outcome in Temporal Lobe Epilepsy With Hippocampal Sclerosis

Neurosurgery ◽

10.1227/neu.0b013e3181fc60ff ◽

2011 ◽

Vol 68 (1) ◽

pp. 98-107 ◽

Cited By ~ 21

Author(s):

Olaf E M G. Schijns ◽

Christian G. Bien ◽

Michael. Majores ◽

Marec. von Lehe ◽

Horst. Urbach ◽

...

Keyword(s):

White Matter ◽

Temporal Lobe ◽

Clinical Characteristics ◽

Hippocampal Sclerosis ◽

Temporal Lobectomy ◽

Seizure Outcome ◽

Anterior Temporal Lobectomy ◽

Selective Amygdalohippocampectomy ◽

Group 2 ◽

Group 1

Abstract BACKGROUND: Temporal lobe gray-white matter abnormalities (GWMA) are frequent morphological aberrances observed on MRI in patients with temporal lobe epilepsy (TLE) in addition to hippocampal sclerosis (HS). OBJECTIVE: To study the influence of temporal pole GWMA on clinical characteristics and seizure outcome in patients with HS operated on for TLE. METHODS: A cohort of 370 patients undergoing surgery for intractable TLE was prospectively collected in an epilepsy surgery data base. Clinical characteristics and seizure outcome of all 58 TLE patients with identified HS and GWMA (group 1) were compared with those of a matched control group of 58 HS patients without GWMA (group 2). Both groups were further subdivided into patients undergoing transsylvian selective amygdalohippocampectomy (sAH) and anterior temporal lobectomy with amygdalohippocampectomy (ATL). RESULTS: The HS plus GWMA patients were significantly younger at epilepsy onset than those without GWMA. In the HS plus GWMA group, 41% of patients were younger than 2 years when they experienced their first seizure in contrast to only 17% of patients with pure HS (P = .004). Seizure outcome was not statistically different between the 2 groups: 75.9% of the patients in group 1 were seizure free (Engel class I) compared with 81% of patients in group 2. Seizure outcome in both groups was about equally successful with selective amygdalohippocampectomy and anterior temporal lobectomy (ns). CONCLUSION: Limited and standard resections in TLE patients with HS are equally successful regardless of the presence of GWMA.

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Tailored Temporal Lobectomy for Medically Intractable Epilepsy

Neurosurgery ◽

10.1227/neu.0b013e318262161d ◽

2012 ◽

Vol 71 (3) ◽

pp. 703-709 ◽

Cited By ~ 16

Author(s):

Steven M. Falowski ◽

David Wallace ◽

Andres Kanner ◽

Michael Smith ◽

Michael Rossi ◽

...

Keyword(s):

Temporal Lobe ◽

Hippocampal Sclerosis ◽

Intractable Epilepsy ◽

Temporal Lobectomy ◽

Class I ◽

Visual Field Defects ◽

Seizure Outcome ◽

Temporal Lobe Resection ◽

Generalized Epilepsy

Abstract BACKGROUND: There have been only a few large series that have used a tailored temporal lobectomy. OBJECTIVE: To clarify whether tailoring a temporal lobe resection will lead to equivalent epilepsy outcomes or have the same predictive factors for success when compared with standard resections. METHODS: Retrospective analysis of 222 patients undergoing a tailored temporal lobe resection. Demographic measures and typical factors influencing outcome were evaluated. RESULTS: Pathology included 222 cases. With a mean follow-up of 5.4 years, 70% of patients achieved Engel class I outcome. A significant factor predicting Engel class I outcome on multivariate analysis was lesional pathology (P = .04). Among patients with hippocampal sclerosis, extent of lateral neocortical resection and hippocampal resection were not statistically associated with Engel class I outcome (P = .93 and P = .24). However, an analysis of Engel class subgroups a to d showed that patients who had a complete hippocampectomy in the total series were more likely to achieve an Engel class Ia outcome (P = .04). This was also true among patients with hippocampal sclerosis (P = .03). Secondarily, generalized seizure (P = .01) predicted outcome less than Engel class I. Predictive of poor outcome was the need for preoperative electrodes (P = .02). Complications included superior quadrant visual field defects, 2 cases of permanent dysphasia, and 3 wound infections. CONCLUSION: Predictors of successful seizure outcome for a tailored temporal lobectomy are similar to standard lobectomy. Patients with secondarily generalized epilepsy and cases in which preoperative subdural electrodes were thought necessary were less likely to achieve class I outcome. Among Engel class I cases, those who had a complete hippocampectomy were more likely to achieve Engel class Ia outcome.

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Memory outcome following transsylvian selective amygdalohippocampectomy in 62 patients with hippocampal sclerosis

Journal of Neurosurgery ◽

10.3171/2008.9.jns08247 ◽

2009 ◽

Vol 110 (6) ◽

pp. 1164-1169 ◽

Cited By ~ 29

Author(s):

Michiharu Morino ◽

Tsutomu Ichinose ◽

Takehiro Uda ◽

Kyoko Kondo ◽

Satoko Ohfuji ◽

...

Keyword(s):

Temporal Lobe ◽

Verbal Memory ◽

Retention Test ◽

Repeated Measures ◽

Hippocampal Sclerosis ◽

Memory Function ◽

Delayed Recall ◽

Nonverbal Memory ◽

Selective Amygdalohippocampectomy ◽

With Memory

Object It remains unclear whether selective amygdalohippocampectomy, an operative technique developed for use in epilepsy surgery to spare unaffected brain tissue and thus minimize the cognitive consequences of temporal lobe surgery, actually leads to a better memory outcome. The present study was performed to determine the effects of selective surgery on memory outcome in patients with intractable mesial temporal lobe epilepsy due to hippocampal sclerosis treated using transsylvian selective amygdalohippocampectomy (TSA). Methods The study population consisted of 62 patients with left hemisphere language dominance who underwent left-(31 patients) or right-sided (31 patients) TSA. All patients underwent comprehensive neuropsychological testing before and 1 month and 1 year after unilateral TSA. Verbal Memory I, Nonverbal Memory I, Total Memory, Attention, and Delayed Recall were assessed using the Wechsler Memory Scale–Revised, whereas Verbal Memory II was assessed using the Miyake Verbal Retention Test (MVRT), and Nonverbal Memory II was assessed using the Benton Visual Retention Test. Separate repeated-measures multivariate analysis of variance (MANOVA) were performed for these intervals with memory scores. Results The results of MANOVA indicated that patients who underwent right-sided TSA showed significant improvements in Verbal Memory I (preoperatively vs 1 month postoperatively, p < 0.0001; and preoperatively vs 1 year postoperatively, p = 0.0002), Nonverbal Memory I (preoperatively vs 1 month postoperatively, p = 0.0003; and preoperatively vs 1 year postoperatively, p = 0.006), and Delayed Recall (preoperatively vs 1 month postoperatively, p = 0.028) at both 1-month and 1-year follow-ups. In addition, Verbal Memory II (MVRT) was also significantly improved 1 year after surgery (p = 0.001). In the group of patients who underwent left-sided TSA, both Verbal Memory I and II were maintained at the same level 1 month after surgery, whereas the Verbal Memory I score 1 year after surgery increased with marginal significance (p = 0.074). In addition, Verbal Memory II showed significant improvement 1 year after surgery (p = 0.049). There were no significant changes in Nonverbal Memory I and II, Attention, or Delayed Recall at either the 1-month or 1-year follow-up. Conclusions Results of the present study indicated that left-sided TSA for hippocampal sclerosis tends to improve verbal memory function with the preservation of other types of memory function. Moreover, right-sided TSA for hippocampal sclerosis can lead to significant improvement in memory function, with memory improvement observed 1 month after right-sided TSA and persisting 1 year after surgery.

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What’s in Your Nomogram? Personalized Prognostication of Verbal Memory Decline after Temporal Lobe Resection in Adults With Epilepsy

Epilepsy Currents ◽

10.1177/15357597211058270 ◽

2021 ◽

pp. 153575972110582

Author(s):

Tracey A. Milligan

Keyword(s):

Temporal Lobe ◽

Verbal Memory ◽

Validation Cohort ◽

Predictive Accuracy ◽

Verbal Learning ◽

Cleveland Clinic ◽

The United States ◽

Clinical Predictors ◽

Memory Decline ◽

Temporal Lobe Resection

Objective This study aims to develop and externally validate models to predict the probability of postoperative verbal memory decline in adults following temporal lobe resection (TLR) for epilepsy using easily accessible preoperative clinical predictors. Methods Multivariable models were developed to predict delayed verbal memory outcome on 3 commonly used measures: Rey Auditory Verbal Learning Test (RAVLT), and Logical Memory (LM), and Verbal Paired Associates (VPA) subtests from Wechsler Memory Scale-Third Edition. Using Harrell’s step-down procedure for variable selection, models were developed in 359 adults who underwent TLR at Cleveland Clinic and validated in 290 adults at 1 of 5 epilepsy surgery centers in the United States or Canada. Results Twenty-nine percent of the development cohort and 26% of the validation cohort demonstrated significant decline on at least 1 verbal memory measure. Initial models had good-to-excellent predictive accuracy (calibration (c) statistic range = .77–.80) in identifying patients with memory decline; however, models slightly underestimated decline in the validation cohort. Model coefficients were updated using data from both cohorts to improve stability. The model for RAVLT included surgery side, baseline memory score, and hippocampal resection. The models for LM and VPA included surgery side, baseline score, and education. Updated model performance was good to excellent (RAVLT c = .81, LM c = .76, VPA c = .78). Model calibration was very good, indicating no systematic over- or under-estimation of risk. Conclusions Nomograms are provided in 2 easy-to-use formats to assist clinicians in estimating the probability of verbal memory decline in adults considering TLR for treatment of epilepsy.

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