Cognitive outcome in selective hippocampectomy versus temporal lobectomy

This study examined cognitive outcome in patients with medically refractory temporal lobe epilepsy (TLE) who underwent one of two different neurosurgical operations to control their seizures: unilateral standard temporal lobectomy (TL) versus unilateral selective hippocampectomy (SH). Comparisons were made between pre- and post-surgery neuropsychological test results of these patients in order to evaluate whether one approach versus another minimizes cognitive deficits post-surgery. It was hypothesized that SH would result in greater preservation of verbal memory and language skills than TL, due to the fact that SH spares more cortex vital to these cognitive functions. It was also hypothesized that patients who underwent surgery on the left side would demonstrate greater post-operative declines in verbal/language skills than patients who underwent surgery on the right side. Right-sided surgical patients were predicted to show improvements in nonverbal cognitive skills. Other demographic and epilepsy variables were projected to play influential roles in post-operative cognitive outcome.; This study involved the examination of archival data. Twenty one patients (11 who underwent SH and ten who underwent TL) with medically refractory TLE between the ages of 20 and 66 who met inclusion criteria for the study underwent neuropsychological testing both prior to and following surgery.; Univariate, descriptive statistics were performed on demographic data. Extent of change scores (from pre- to post-operative time of testing) were computed and an index of reliable change was calculated to compare scores across different measures. Two way ANOVA's enabled examination of group differences and interactions. Bivariate linear regression analyses were performed to examine relationships between demographic and epilepsy related variables and scores on neuropsychological measures.; Results provide evidence that SH may result in greater preservation of visual confrontation naming than does TL. The risks of SH are considered more extreme, in terms of surgical procedure, and patients who undergo SH may have a higher probability of experiencing continued seizures than patients who undergo TL. As such, for perhaps only a sub-population of patients, SH could be considered as an alternative that may spare more cognitive functions. For these select individuals, the benefits of preserved cognitive functioning appear to outweigh the increased surgical risks and potential continued post-operative seizure activity associated with SH. Additionally, results lend empirical support to the assertion that surgical intervention contributes to improvement in mood and general life satisfaction.