Better object recognition and naming outcome withMRI‐guided stereotactic laser amygdalohippocampotomy for temporal lobe epilepsy

Abstract

SUMMARY OBJECTIVES Temporal lobe epilepsy (TLE) patients experience significant deficits in category-related object recognition and naming following standard surgical approaches. These deficits may result from a decoupling of core processing modules (e.g., language, visual processing, semantic memory), due to “collateral damage” to temporal regions outside the hippocampus following open surgical approaches. We predicted stereotactic laser amygdalohippocampotomy (SLAH) would minimize such deficits because it preserves white matter pathways and neocortical regions critical for these cognitive processes. METHODS Tests of naming and recognition of common nouns (Boston Naming Test) and famous persons were compared with nonparametric analyses using exact tests between a group of nineteen patients with medically-intractable mesial TLE undergoing SLAH (10 dominant, 9 nondominant), and a comparable series of TLE patients undergoing standard surgical approaches (n=39) using a prospective, non-randomized, non-blinded, parallel group design. RESULTS Performance declines were significantly greater for the dominant TLE patients undergoing open resection versus SLAH for naming famous faces and common nouns (F=24.3, p<.0001, η2=.57, & F=11.2, p<.001, η2=.39, respectively), and for the nondominant TLE patients undergoing open resection versus SLAH for recognizing famous faces (F=3.9, p<.02, η2=.19). When examined on an individual subject basis, no SLAH patients experienced any performance declines on these measures. In contrast, 32 of the 39 undergoing standard surgical approaches declined on one or more measures for both object types (p<.001, Fisher’s exact test). Twenty-one of 22 left (dominant) TLE patients declined on one or both naming tasks after open resection, while 11 of 17 right (non-dominant) TLE patients declined on face recognition. SIGNIFICANCE Preliminary results suggest 1) naming and recognition functions can be spared in TLE patients undergoing SLAH, and 2) the hippocampus does not appear to be an essential component of neural networks underlying name retrieval or recognition of common objects or famous faces.

Getting the best outcomes from epilepsy surgery

“…Computer‐generated trajectories improve ablation volume and calculated trajectory risk compared to when manually planned (Fig 3). 84, 85 In a nonrandomized comparison, MgLiTT gave similar outcomes to conventional surgery 86. MgLiTT may result in less adverse cognitive effects, is repeatable, does not preclude subsequent surgery, and may represent a minimally invasive first‐line treatment for MTLE.…”

Emerging surgical therapies in the treatment of pediatric epilepsy

“…One prospective study of temporal lobe epilepsy compared 19 adult patients undergoing MRgLITT treatment with 39 adult patients undergoing standard temporal lobectomy for temporal lobe epilepsy in the dominant hemisphere. Patients undergoing craniotomy had a more significant decline in facial recognition and naming (P<0.0001) (57). Rates of seizure control were similar in both groups, with 57.9% of patients treated with MRgLITT and 61.5% who underwent craniotomy achieving seizure freedom.…”

Magnetic Resonance Imaging-Guided Laser Interstitial Thermal Therapy for Treatment of Drug-Resistant Epilepsy

“…In 2015, Drane et al [25] compared the pre-and postoperative performance between the group that underwent ATL (n = 39) and those that had SLAH (n = 19), using the Boston Naming Test and the Iowa Famous Faces test. The Boston Naming Test and the Iowa Famous Faces test assess visual confrontation naming and recognition abilities, respectively.…”