Abstracts

Cognitive and Seizure Outcomes for Anterior Temporal Lobectomy versus Laser Ablation in Temporal Lobe Epilepsy

Abstract number : 2.311
Submission category : 9. Surgery / 9A. Adult
Year : 2023
Submission ID : 741
Source : www.aesnet.org
Presentation date : 12/3/2023 12:00:00 AM
Published date :

Authors :
Presenting Author: Ellery Wheeler, BS – McGovern Medical School at UTHealth Houston

Kathryn Snyder, BE – Graduate Research Assistant, Neurosurgery, Vivian L. Smith Department of Neurosurgery, McGovern Medical School at UT Health Houston; Oscar Woolnough, PhD – Postdoctoral Research Fellow, Neurosurgery, Vivian L. Smith Department of Neurosurgery, McGovern Medical School at UT Health Houston; Josh Bandopadhay, BA – MD Candidate, Vivian L. Smith Department of Neurosurgery, McGovern Medical School at UT Health Houston; Joshua Breier, PhD – Vivian L. Smith Department of Neurosurgery, McGovern Medical School at UT Health Houston; Yosefa Modiano, PhD – Clinical Neuropsychologist, Vivian L. Smith Department of Neurosurgery, McGovern Medical School at UT Health Houston; Nitin Tandon, MD – Neurosurgeon, Neurosurgery, Vivian L. Smith Department of Neurosurgery, McGovern Medical School at UT Health Houston

Rationale: Anterior temporal lobectomy (ATL) is an effective surgical approach for medically refractory temporal lobe epilepsy (TLE) that has established costs to cognitive functions, including word retrieval and memory consolidation. MRI-guided laser interstitial thermal therapy (LITT) is an alternative to ATL that is minimally invasive and limits damage to surrounding non-epileptogenic functional tissue, potentially preserving cognitive skills previously sacrificed to achieve seizure freedom. Prior studies have demonstrated improved language and memory outcomes for LITT, but no investigations have directly compared these functions as well as seizure outcomes across both approaches. Accordingly, we investigated language, memory, and seizure outcomes from a large series of individuals who underwent ATL or LITT by a single surgeon from a single institution.

Methods: Data were obtained from 163 patients (17-73 years old) who underwent surgical treatment for TLE from 2008 to 2022, including ATL with amygdalohippocampectomy (ATL+AH) (n=102) and selective LITT of the hippocampus and amygdala (n=61). Patients underwent neuropsychological testing at baseline and on average six months following surgery. Post-operative changes in language, verbal memory, and non-verbal memory were assessed at a domain level as a function of surgery type and hemisphere. Significant interactions were then explored at the level of individual tests to determine specific functional changes. Seizure outcomes (ILAE scores) were collected at the time of post-operative neuropsychological testing.

Results: We found a significant effect of surgery type and hemispheric dominance for verbal memory (p = .0426) with larger declines following ATL+AH versus LITT in the dominant hemisphere only. Hemispheric dominance was significant for both language (p = 0.0031) and verbal memory (p < 0.01). For dominant hemisphere surgeries, visual confrontation naming raw scores declined by 4.72
Surgery