Neuropsychology Outcomes Following Trephine Epilepsy Surgery: The Inferior Temporal Gyrus Approach for Amygdalohippocampectomy in Medically Refractory Mesial Temporal Lobe Epilepsy

Schoenberg, Mike R.; Clifton, William; Sever, R; Vale, Fernando Ĺ.

doi:10.1093/neuros/nyx302

Cited by 18 publications

(19 citation statements)

References 55 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Wada asymmetry (e.g., WMA group), when considered in conjunction with language dominance, provided clarity into the risk of decline in neuropsychological function. These data support prior research that indicates that verbal memory and visual confrontation naming are at the most risk of decline for patients with no Wada asymmetry and with a dominant AH, even in patients with selective ATL procedures to treat pharmacoresistent epilepsy . Change in visual memory functioning has been shown to be variable across literature.…”

Section: Discussionsupporting

confidence: 84%

“…Given the literature establishing that patients with language‐dominant (left) TLE tend to experience greater risk for decline in memory and confrontation naming, we completed sub‐analyses of Wada asymmetry, sub‐classifying WMA by those having left or right TLE (see Table ). ANOVA comparing side of seizure onset within the WMA and No‐WMA groups found patients with left mTLE who showed No‐WMA significantly declined in immediate (RAVLT immediate delay, p = 0.001) and delayed (RAVLT 30‐min delay, p = 0.001) verbal recall, but exhibited an improvement in perceptual reasoning (WAIS‐IV PRI, p = 0.035) and depressive symptoms (BDI‐II, p = 0.004).…”

Section: Resultsmentioning

confidence: 99%

“…These data support prior research that indicates that verbal memory and visual confrontation naming are at the most risk of decline for patients with no Wada asymmetry and with a dominant AH, even in patients with selective ATL procedures to treat pharmacoresistent epilepsy. 8,33 Change in visual memory functioning has been shown to be variable across literature. Contrary to the findings of Kneebone et al, visual memory decline was small, which is consistent with the majority of the literature.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Wada asymmetry in patients with drug‐resistant mesial temporal lobe epilepsy: Implications for postoperative neuropsychological outcomes

et al. 2018

View full text Add to dashboard Cite

SummaryObjectiveThis study reports neuropsychological outcomes based on preoperative Wada testing in patients with drug‐resistant mesial temporal lobe epilepsy (mTLE).MethodsPatient records were retrospectively reviewed as part of a larger database. Patients with a diagnosis of TLE based on seizure semiology and long‐term surface video–electroencephalography (EEG) were identified. These patients underwent preoperative and postoperative testing including advanced imaging (magnetic resonance imaging [MRI]), Wada testing, and neuropsychological assessment. Decrements in neuropsychological function were noted in comparison of pre‐ and postoperative studies. Patients had regular follow‐up in the multidisciplinary epilepsy clinic to assess seizure outcomes. All participants had Engel class I/II outcome following selective amygdalohippocampectomy (AH) via the inferior temporal gyrus (ITG) approach.ResultsForty‐eight patients with electrographic and clinical semiology consistent with unilateral mTLE were identified. Left mTLE was identified in 28 patients (58.3%), whereas 20 patients (41.7%) had right mTLE. Language‐dominant hemisphere resections were performed on 23 patients (47.9%) (all left‐sided surgery), whereas 25 (52.1%) had language nondominant resection (all right‐sided and five left‐sided surgery). Twenty‐two participants (45.8%) showed no Wada memory asymmetry (No‐WMA), whereas 26 (54.2%) exhibited Wada memory asymmetry (WMA). Postoperatively, analysis of variance (ANOVA) found that the No‐WMA group exhibited a decline in verbal memory, but average scores on measures of nonverbal reasoning, general intelligence, and mood improved. Alternatively, patients with WMA did not show declines in memory postoperatively, and also exhibited improved nonverbal reasoning and general intelligence. Neither group exhibited reliable decline in verbal fluency or visual confrontation naming.SignificanceWada procedures for predicting surgical outcome from elective temporal surgery have been criticized and remain an area of active debate. However, decades of data across multiple epilepsy centers have demonstrated the value of Wada for reducing unanticipated neuropsychological adverse effects of surgical treatment. These data show that no Wada memory asymmetry increases the risk for neuropsychological decline following ITG approach for selective AH for drug‐resistant mTLE.

show abstract

Section: Discussionsupporting

confidence: 84%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Wada asymmetry in patients with drug‐resistant mesial temporal lobe epilepsy: Implications for postoperative neuropsychological outcomes

et al. 2018

View full text Add to dashboard Cite

show abstract

“…No gross visual field loss was identified preoperatively on confrontation testing. Normal preoperative memory function was documented based on neuro-psychology testing in all patients according to protocol [18]. Language dominance was determined using Wada testing in 8 patients and more recently, five patients using fMRI.…”

Section: Resultsmentioning

confidence: 99%

“…Patients with a normal hippocampus have a higher risk of post-operative deficit even with selective resections [10,12,18]. The epileptogenic focus in well-defined lesions (such as those with certain low grade gliomas and cavernous malformations) is understood to be within the MRI visible portion of the lesion and its immediate surroundings [1].…”

Section: Discussionmentioning

confidence: 99%

Surgery of the amygdala and uncus: a case series of glioneuronal tumors

et al. 2020

View full text Add to dashboard Cite

Background Patients with a lesion within the amygdala and uncus may develop temporal lobe epilepsy despite having functional mesial structures. Resection of functional hippocampus and surrounding structures may lead to unacceptable iatrogenic deficits. To our knowledge, there is limited descriptions of surgical techniques for selectively resecting the amygdala and uncus lesions while preserving the hippocampus in patients with language-dominant temporal lobe pathology. Methods Thirteen patients with language-dominant temporal lobe epilepsy related to amygdala-centric lesions were identified. Patients with sclerosis of the mesial structures or evidence of pathology outside of the amygdala-uncus region were excluded. Neuropsychological evaluation confirmed normal function of the mesial structures ipsilateral to the lesion. All patients were worked up with video-EEG, high-resolution brain MRI, neuro-psychology evaluation, and either Wada or functional MRI testing. Results All patients underwent selective resection of the lesion including amygdala and uncus with preservation of the hippocampus via a transcortical inferior temporal gyrus approach to the mesial temporal lobe. Pathology was compatible with glioneuronal tumors. Post-operative MRI demonstrated complete resection in all patients. Eight of the thirteen patients underwent post-operative neuropsychology evaluations and did not demonstrate any significant decline in tasks of delayed verbal recall or visual memory based on the Rey Auditory Verbal Learning Test (RAVLT). One patient showed a slight decrease in confrontation naming using the Boston Naming Test (BNT). Seizure freedom (Engel class I) was achieved in 12 of 13 patients. Conclusion Selective transcortical amygdala and uncus resection with hippocampus preservation may be a reasonable way to achieve seizure control while sparing functional mesial structures.

show abstract

Naming fMRI-guided white matter language tract volumes influence naming decline after temporal lobe resection

Trimmel,

Vos,

Binding

et al. 2024

J Neurol

View full text Add to dashboard Cite

Objective The aim of this study was to explore the relation of language functional MRI (fMRI)-guided tractography with postsurgical naming decline in people with temporal lobe epilepsy (TLE). Methods Twenty patients with unilateral TLE (9 left) were studied with auditory and picture naming functional MRI tasks. Activation maxima in the left posterobasal temporal lobe were used as seed regions for whole-brain fibre tractography. Clinical naming performance was assessed preoperatively, 4 months, and 12 months following temporal lobe resection. Volumes of white matter language tracts in both hemispheres as well as tract volume laterality indices were explored as moderators of postoperative naming decline using Pearson correlations and multiple linear regression with other clinical variables. Results Larger volumes of white matter language tracts derived from auditory and picture naming maxima in the hemisphere of subsequent surgery as well as stronger lateralization of picture naming tract volumes to the side of surgery correlated with greater language decline, which was independent of fMRI lateralization status. Multiple regression for picture naming tract volumes was associated with a significant decline of naming function with 100% sensitivity and 93% specificity at both short-term and long-term follow-up. Interpretation Naming fMRI-guided white matter language tract volumes relate to postoperative naming decline after temporal lobe resection in people with TLE. This can assist stratification of surgical outcome and minimize risk of postoperative language deficits in TLE.

show abstract

Neuropsychology Outcomes Following Trephine Epilepsy Surgery: The Inferior Temporal Gyrus Approach for Amygdalohippocampectomy in Medically Refractory Mesial Temporal Lobe Epilepsy

Cited by 18 publications

References 55 publications

Wada asymmetry in patients with drug‐resistant mesial temporal lobe epilepsy: Implications for postoperative neuropsychological outcomes

Wada asymmetry in patients with drug‐resistant mesial temporal lobe epilepsy: Implications for postoperative neuropsychological outcomes

Surgery of the amygdala and uncus: a case series of glioneuronal tumors

Naming fMRI-guided white matter language tract volumes influence naming decline after temporal lobe resection

Contact Info

Product

Resources

About