Memory outcome after temporal lobe epilepsy surgery: corticoamygdalohippocampectomy versus selective amygdalohippocampectomy

Clinical article

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Object

The aim of this study was to compare IQ and memory outcomes at the 1-year follow-up in patients with medically refractory mesial temporal lobe epilepsy (MTLE) due to hippocampal sclerosis. All patients were treated using a corticoamygdalohippocampectomy (CAH) or a selective amygdalohippocampectomy (SelAH).

Methods

The data of 256 patients who underwent surgery for MTLE were retrospectively evaluated. One hundred twenty-three patients underwent a CAH (63 [right side] and 60 [left side]), and 133 underwent an SelAH (61 [right side] and 72 [left side]). A comprehensive neuropsychological test battery was assessed before and 1 year after surgery, and the results were compared between the surgical procedures. Furthermore, seizure outcome was compared using the Engel classification scheme.

Results

At 1-year follow-up, there was no statistically significant difference between the surgical approaches with respect to seizure outcome. Overall, IQ scores showed improvement, but verbal IQ decreased after left SelAH. Verbal memory impairment was seen after left-sided resections especially in cases of SelAH, and nonverbal memory decreased after right-sided resection, especially for CAH. Left-sided resections produced some improvement in nonverbal memory. Older age at surgery, longer duration of seizures, greater seizure frequency before surgery, and poor seizure control after surgery were associated with poorer memory.

Conclusions

Both CAH and SelAH can lead to several cognitive impairments depending on the side of the surgery. The authors suggest that the optimal type of surgical approach should be decided on a case-by-case basis.

Abbreviations used in this paper: CAH = corticoamygdalohippocampectomy; EEG = electroencephalography; FIQ = full IQ; HS = hippocampal sclerosis; LM = logical memory; MNI = Montreal Neurological Institute; MTLE = mesial temporal lobe epilepsy; PIQ = performance IQ; RAVLT = Rey Auditory Verbal Learning Test; ROCF = Rey-Osterrieth Complex Figure; SelAH = selective amygdalohippocampectomy; VIQ = verbal IQ; WMS-R = Wechsler Memory Scale-Revised; WAIS-R = Wechsler Adult Intelligence Scale-Revised.
Article Information

Contributor Notes

Address correspondence to: Taner Tanriverdi, M.D., Department of Neurosurgery, Montreal Neurological Institute and Hospital, 3801 Rue University, Suite 109, Montreal, Quebec H3A 2B4, Canada. email: tanerato2000@yahoo.com.Please include this information when citing this paper: published online December 4, 2009; DOI: 10.3171/2009.10.JNS09677.

© AANS, except where prohibited by US copyright law.

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