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Intraoperative Hippocampal Cooling and Wada Memory Testing in the Evaluation of Amnesia Risk Following Anterior Temporal Lobectomy

Intraoperative Hippocampal Cooling and Wada Memory Testing in the Evaluation of Amnesia Risk... Abstract Objective: To determine the efficacy of memory testing following localized thermal inactivation (cooling) of the hippocampus during epilepsy surgery to assess risk for postoperative memory decline. Design: Memory was assessed after intraoperative thermal inactivation of the hippocampus and during the Wada procedure to help determine the clinical utility of each procedure. Setting: A university hospital, comprehensive epilepsy surgery program. Patients: Individuals undergoing unilateral temporal lobectomy for relief of intractable seizures. Procedure: After temporal tip resection, iced liquid was irrigated into the temporal horn of the lateral ventricle until the hippocampus was "cooled." Main Outcome Measures: Multiple neuropsychological measures of learning and memory. Results: Wada memory testing suggested risk for memory impairment in 15 patients while cooling indicated risk in only five patients. Predictions arising from the two procedures were concordant in 13 patients and discordant in 12 patients. Among the 12 inconsistent predictions, hippocampal cooling suggested adequate contralateral memory support in 11 (92%) of 12 patients, and none of these 11 patients had a postoperative anterograde Conclusion: Intraoperative hippocampal cooling may be useful in determining the risk of postoperative memory disorder among selected patients undergoing epilepsy surgery. References 1. Penfield W, Mathieson G. Memory: autopsy findings and comments on the role of the hippocampus in experimental recall . Arch Neurol . 1974;31:145-154.Crossref 2. Milner B, Branch C, Rasmussen T. Study of short-term memory after intracarotid injection of sodium Amytal . Trans Am Neurol Assoc . 1962;87:224-226. 3. Wada J, Rasmussen T. Intracarotid injection of sodium Amytal for the lateralization of cerebral speech dominance: experimental and clinical observations . J Neurosurg . 1960;17:266-282.Crossref 4. Loring DW, Meador KJ, Lee GP, King DW. Amobarbital Effects and Lateralized Brain Function: The Wada Test . New York, NY: Springer-Verlag NY Inc; 1992. 5. Perrine K. Future directions for functional mapping . Epilepsia . 1994;35( (suppl 6) ):S90-S102.Crossref 6. Loring DW, Lee GP, Meador KJ, King DW. Does memory assessment during amobarbital testing predict postsurgical amnesia? J Epilepsy . 1991;4:19-24.Crossref 7. Novelly RA, Williamson PD. Incidence of false-positive memory impairment in the intracarotid Amytal procedure . Epilepsia . 1989;30:711. Abstract. 8. Loring DW, Lee GP, Meador KJ, et al. The intracarotid amobarbital procedure as a predictor of memory failure following unilateral temporal lobectomy . Neurology . 1990;40:605-610.Crossref 9. Girvin JP, McGlone J, McLachlan RS, Blume WT. Validity of the sodium amobarbital test for memory in selected patients . Epilepsia . 1987;28:636. Abstract. 10. Snyder PJ, Novelly RA. An international survey of the administration and interpretation of the intracarotid sodium Amytal procedure (IAP) . J Clin Exp Neuropsychol . 1990;12:71. Abstract.Crossref 11. Rausch R, Silfvenius H, Wieser H-G, Dodrill CB, Meador KJ, Jones-Gotman M. Intra-arterial amobarbital procedures . In: Engel J Jr, ed. Surgical Treatment of the Epilepsies . 2nd ed. New York, NY: Raven Press; 1993:341-357. 12. Sperling MR, Sutherling WW, Nuwer MR. New techniques for evaluating patients for epilepsy surgery . In: Engel J Jr, ed. Surgical Treatment of the Epilepsies . New York, NY: Raven Press; 1987:235-258. 13. Jack CR Jr, Sharbrough FW, Cascino GD, et al. Magnetic resonance image—based hippocampal volumetry: correlation with outcome after temporal lobectomy . Ann Neurol . 1992;31:138-146.Crossref 14. Loring DW, Murro AM, Meador KJ, et al. Wada memory testing and hippocampal volume measurements in the evaluation of temporal lobectomy . Neurology . 1993;43:1789-1793.Crossref 15. Loring DW, Herman BP, Meador KJ, et al. Amnesia after unilateral temporal lobectomy: a case report . Epilepsia . 1994;35:757-763.Crossref 16. Duncan R, Patterson J, Hadley DM, et al. CT, MR, and SPECT imaging in temporal lobe epilepsy . J Neurol Neurosurg Psychiatry . 1990;53:11-15.Crossref 17. Chee MWL, Morris HH, Antar MA, et al. Presurgical evaluation of temporal lobe epilepsy using interictal temporal spikes and positron emission tomography . Arch Neurol . 1993;50:45-48.Crossref 18. Huh K, Meador KJ, Lee GP, et al. Human hippocampal EEG: effects of behavioral activation . Neurology . 1990;40:1177-1181.Crossref 19. Lee GP, Meador KJ, Loring, DW, et al. Behavioral activation of human hippocampal EEG: relationship to recent memory . J Epilepsy . 1990;3:137-142.Crossref 20. Chelune GJ. The role of neuropsychological assessment in the presurgical evaluation of the epilepsy surgery candidate . In: Wyler AR, Hermann BP, eds. The Surgical Management of Epilepsy . Boston, Mass: Butterworth-Heinemann; 1994: 78-89. 21. Halgren E, Wilson CL, Stapleton JM. Human medial temporal-lobe stimulation disrupts both formation and retrieval of recent memories . Brain Cogn . 1985; 4:287-295.Crossref 22. Lee GP, Loring, DW, Smith JR, Flanigin HF. Material specific learning during electrical stimulation of the human hippocampus . Cortex . 1990;26:433-442.Crossref 23. Flanigin HF, Schlosberg A, Power J, Smith JR. Evaluation of memory by localized intraoperative cooling . Epilepsia . 1985;26:543. Abstract. 24. Lee GP, Smith JR, Loring DW, Flanigin HF. Intraoperative thermal inactivation of the hippocampus in an effort to prevent global amnesia following temporal lobectomy. Epilepsia. In press. 25. Baldwin M, Frost LL, Wood CD, Lewis SA. Effect of hypothermia on epileptiform activity in the primate temporal lobe . Science . 1956;124:931-932.Crossref 26. Moseley JI, Ojemann GA, Ward AA Jr. Unit activity in experimental epileptic foci during focal cortical hypothermia . Exp Neurol . 1972;37:164-178.Crossref 27. Ommaya AK, Baldwin M. Extravascular local cooling of the brain in man . J Neurosurg . 1963;20:8-20.Crossref 28. Vastola EF, Homan R, Rosen A. Inhibition of focal seizures by moderate hypothermia . Arch Neurol . 1969;20:430-439.Crossref 29. Pasztor E, Tomka I. Changes of electrocorticography activity in response to direct brain surface cooling in epileptic patients . Acad Sci Hung Acta Physiol . 1979;36:277-292. 30. Varney NR, Benton AL. Tactile perception of direction in relation to handedness and familial handedness . Neuropsychologia . 1975;13:449-454.Crossref 31. Loring DW, Lee GP, Meador KJ. Intracarotid amobarbital (Wada) assessment . In: Wyler AR, Hermann BP, eds. The Surgical Management of Epilepsy . Boston, Mass: Butterworth-Heinemann; 1994:97-110. 32. Brown J. Some tests of the decay theory of immediate memory . Q J Exp Psychol . 1956;2:152-167. 33. Peterson LR, Peterson MJ. Short-term retention of individual items . J Exp Psychol . 1959;58:31-35.Crossref 34. Buschke H, Fuld PA. Evaluating storage, retention, and retrieval in disordered memory and learning . Neurology . 1974;24:1019-1025.Crossref 35. Osterrieth PA. Le test de copie d'une figure complexe . Arch Psychol . 1944; 30:206-356. 36. Engel J Jr. Outcome with respect to epileptic seizures . In: Engel J Jr, ed. Surgical Treatment of the Epilepsies . New York, NY: Raven Press; 1987: 553-571. 37. Dinner DS, Lüders H, Morris HH, Wyllie E, Kramer RE. Validity of intracarotid sodium amobarbital (Wada test) for evaluation of memory function . Neurology . 1987;37( (suppl 1) ):142. Abstract.Crossref 38. Jack CR Jr, Nichols DA, Sharbrough FW, Marsh WR, Petersen RC. Selective posterior cerebral artery Amytal test for evaluating memory function before surgery for temporal lobe seizure . Radiology . 1988;168:787-793.Crossref 39. Kanner AM, Kaydanova Y, deToledo-Morrell L, et al. Tailored anterior temporal lobectomy: relation between extent of resection of mesial structures and post-surgical seizure outcome . Arch Neurol . 1995;52:173-178.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Neurology American Medical Association

Intraoperative Hippocampal Cooling and Wada Memory Testing in the Evaluation of Amnesia Risk Following Anterior Temporal Lobectomy

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Publisher
American Medical Association
Copyright
Copyright © 1995 American Medical Association. All Rights Reserved.
ISSN
0003-9942
eISSN
1538-3687
DOI
10.1001/archneur.1995.00540330035011
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Abstract

Abstract Objective: To determine the efficacy of memory testing following localized thermal inactivation (cooling) of the hippocampus during epilepsy surgery to assess risk for postoperative memory decline. Design: Memory was assessed after intraoperative thermal inactivation of the hippocampus and during the Wada procedure to help determine the clinical utility of each procedure. Setting: A university hospital, comprehensive epilepsy surgery program. Patients: Individuals undergoing unilateral temporal lobectomy for relief of intractable seizures. Procedure: After temporal tip resection, iced liquid was irrigated into the temporal horn of the lateral ventricle until the hippocampus was "cooled." Main Outcome Measures: Multiple neuropsychological measures of learning and memory. Results: Wada memory testing suggested risk for memory impairment in 15 patients while cooling indicated risk in only five patients. Predictions arising from the two procedures were concordant in 13 patients and discordant in 12 patients. Among the 12 inconsistent predictions, hippocampal cooling suggested adequate contralateral memory support in 11 (92%) of 12 patients, and none of these 11 patients had a postoperative anterograde Conclusion: Intraoperative hippocampal cooling may be useful in determining the risk of postoperative memory disorder among selected patients undergoing epilepsy surgery. References 1. Penfield W, Mathieson G. Memory: autopsy findings and comments on the role of the hippocampus in experimental recall . Arch Neurol . 1974;31:145-154.Crossref 2. Milner B, Branch C, Rasmussen T. Study of short-term memory after intracarotid injection of sodium Amytal . Trans Am Neurol Assoc . 1962;87:224-226. 3. Wada J, Rasmussen T. Intracarotid injection of sodium Amytal for the lateralization of cerebral speech dominance: experimental and clinical observations . J Neurosurg . 1960;17:266-282.Crossref 4. Loring DW, Meador KJ, Lee GP, King DW. Amobarbital Effects and Lateralized Brain Function: The Wada Test . New York, NY: Springer-Verlag NY Inc; 1992. 5. Perrine K. Future directions for functional mapping . Epilepsia . 1994;35( (suppl 6) ):S90-S102.Crossref 6. Loring DW, Lee GP, Meador KJ, King DW. Does memory assessment during amobarbital testing predict postsurgical amnesia? J Epilepsy . 1991;4:19-24.Crossref 7. Novelly RA, Williamson PD. Incidence of false-positive memory impairment in the intracarotid Amytal procedure . Epilepsia . 1989;30:711. Abstract. 8. Loring DW, Lee GP, Meador KJ, et al. The intracarotid amobarbital procedure as a predictor of memory failure following unilateral temporal lobectomy . Neurology . 1990;40:605-610.Crossref 9. Girvin JP, McGlone J, McLachlan RS, Blume WT. Validity of the sodium amobarbital test for memory in selected patients . Epilepsia . 1987;28:636. Abstract. 10. Snyder PJ, Novelly RA. An international survey of the administration and interpretation of the intracarotid sodium Amytal procedure (IAP) . J Clin Exp Neuropsychol . 1990;12:71. Abstract.Crossref 11. Rausch R, Silfvenius H, Wieser H-G, Dodrill CB, Meador KJ, Jones-Gotman M. Intra-arterial amobarbital procedures . In: Engel J Jr, ed. Surgical Treatment of the Epilepsies . 2nd ed. New York, NY: Raven Press; 1993:341-357. 12. Sperling MR, Sutherling WW, Nuwer MR. New techniques for evaluating patients for epilepsy surgery . In: Engel J Jr, ed. Surgical Treatment of the Epilepsies . New York, NY: Raven Press; 1987:235-258. 13. Jack CR Jr, Sharbrough FW, Cascino GD, et al. Magnetic resonance image—based hippocampal volumetry: correlation with outcome after temporal lobectomy . Ann Neurol . 1992;31:138-146.Crossref 14. Loring DW, Murro AM, Meador KJ, et al. Wada memory testing and hippocampal volume measurements in the evaluation of temporal lobectomy . Neurology . 1993;43:1789-1793.Crossref 15. Loring DW, Herman BP, Meador KJ, et al. Amnesia after unilateral temporal lobectomy: a case report . Epilepsia . 1994;35:757-763.Crossref 16. Duncan R, Patterson J, Hadley DM, et al. CT, MR, and SPECT imaging in temporal lobe epilepsy . J Neurol Neurosurg Psychiatry . 1990;53:11-15.Crossref 17. Chee MWL, Morris HH, Antar MA, et al. Presurgical evaluation of temporal lobe epilepsy using interictal temporal spikes and positron emission tomography . Arch Neurol . 1993;50:45-48.Crossref 18. Huh K, Meador KJ, Lee GP, et al. Human hippocampal EEG: effects of behavioral activation . Neurology . 1990;40:1177-1181.Crossref 19. Lee GP, Meador KJ, Loring, DW, et al. Behavioral activation of human hippocampal EEG: relationship to recent memory . J Epilepsy . 1990;3:137-142.Crossref 20. Chelune GJ. The role of neuropsychological assessment in the presurgical evaluation of the epilepsy surgery candidate . In: Wyler AR, Hermann BP, eds. The Surgical Management of Epilepsy . Boston, Mass: Butterworth-Heinemann; 1994: 78-89. 21. Halgren E, Wilson CL, Stapleton JM. Human medial temporal-lobe stimulation disrupts both formation and retrieval of recent memories . Brain Cogn . 1985; 4:287-295.Crossref 22. Lee GP, Loring, DW, Smith JR, Flanigin HF. Material specific learning during electrical stimulation of the human hippocampus . Cortex . 1990;26:433-442.Crossref 23. Flanigin HF, Schlosberg A, Power J, Smith JR. Evaluation of memory by localized intraoperative cooling . Epilepsia . 1985;26:543. Abstract. 24. Lee GP, Smith JR, Loring DW, Flanigin HF. Intraoperative thermal inactivation of the hippocampus in an effort to prevent global amnesia following temporal lobectomy. Epilepsia. In press. 25. Baldwin M, Frost LL, Wood CD, Lewis SA. Effect of hypothermia on epileptiform activity in the primate temporal lobe . Science . 1956;124:931-932.Crossref 26. Moseley JI, Ojemann GA, Ward AA Jr. Unit activity in experimental epileptic foci during focal cortical hypothermia . Exp Neurol . 1972;37:164-178.Crossref 27. Ommaya AK, Baldwin M. Extravascular local cooling of the brain in man . J Neurosurg . 1963;20:8-20.Crossref 28. Vastola EF, Homan R, Rosen A. Inhibition of focal seizures by moderate hypothermia . Arch Neurol . 1969;20:430-439.Crossref 29. Pasztor E, Tomka I. Changes of electrocorticography activity in response to direct brain surface cooling in epileptic patients . Acad Sci Hung Acta Physiol . 1979;36:277-292. 30. Varney NR, Benton AL. Tactile perception of direction in relation to handedness and familial handedness . Neuropsychologia . 1975;13:449-454.Crossref 31. Loring DW, Lee GP, Meador KJ. Intracarotid amobarbital (Wada) assessment . In: Wyler AR, Hermann BP, eds. The Surgical Management of Epilepsy . Boston, Mass: Butterworth-Heinemann; 1994:97-110. 32. Brown J. Some tests of the decay theory of immediate memory . Q J Exp Psychol . 1956;2:152-167. 33. Peterson LR, Peterson MJ. Short-term retention of individual items . J Exp Psychol . 1959;58:31-35.Crossref 34. Buschke H, Fuld PA. Evaluating storage, retention, and retrieval in disordered memory and learning . Neurology . 1974;24:1019-1025.Crossref 35. Osterrieth PA. Le test de copie d'une figure complexe . Arch Psychol . 1944; 30:206-356. 36. Engel J Jr. Outcome with respect to epileptic seizures . In: Engel J Jr, ed. Surgical Treatment of the Epilepsies . New York, NY: Raven Press; 1987: 553-571. 37. Dinner DS, Lüders H, Morris HH, Wyllie E, Kramer RE. Validity of intracarotid sodium amobarbital (Wada test) for evaluation of memory function . Neurology . 1987;37( (suppl 1) ):142. Abstract.Crossref 38. Jack CR Jr, Nichols DA, Sharbrough FW, Marsh WR, Petersen RC. Selective posterior cerebral artery Amytal test for evaluating memory function before surgery for temporal lobe seizure . Radiology . 1988;168:787-793.Crossref 39. Kanner AM, Kaydanova Y, deToledo-Morrell L, et al. Tailored anterior temporal lobectomy: relation between extent of resection of mesial structures and post-surgical seizure outcome . Arch Neurol . 1995;52:173-178.Crossref

Journal

Archives of NeurologyAmerican Medical Association

Published: Sep 1, 1995

References