Authors :
Presenting Author: Racheal Smetana, PsyD, ABPP – University of Virginia Health
Matthew Rumschlag, MD – University of Virginia Health
Anthony Longoria, PhD – University of Virginia Health
Nikhil Reddy, , – University of Virginia Health
Ifrah Zawar, MD MS-CR – University of Virginia Heatlh
Shayan Moosa, MD – University of Virginia Heatlh
W. Jeffrey Elias, MD – University of Virginia Heatlh
Kristine Ziemba, MD, PhD – University of Virginia Health
Nathan Fountain, MD – University of Virginia Heatlh
Rationale:
Anterior temporal lobectomy (ATL) and laser interstitial thermal therapy (LITT) are effective surgical approaches for treating temporal lobe epilepsy. Both approaches come with a degree of cognitive risk, with most previous studies focused on neurocognitive outcomes associated with dominant hemisphere surgery. The purpose of the current study was to investigate neurocognitive outcomes following ATL and LITT in patients with dominant and non-dominant mesial temporal lobe epilepsy. Methods:
This is a single center, retrospective cohort of patients who underwent temporal lobe surgery between 2013 and 2023. Of all patients undergoing surgery, 25 patients underwent neuropsychological testing pre- and post-operatively (LITT n=19; ATL n=6). The cohort was predominantly right-handed (89%) with 62% females and 62% undergoing dominant-hemisphere surgery. Overall mean age at time of surgery was 40 years and did not differ significantly between surgery type (ATL mean=36; LITT mean=42). Age of seizure onset was earlier in ATL patients (mean=9.8 years) than LITT (mean=23.7 years). Average preoperative IQ was similar between surgery types (ATL mean=90.6; LITT mean=87.8). A linear mixed model was used to account for unequal sample sizes between surgery types. Twelve neurocognitive scores were analyzed within the domains of language, verbal memory, visual memory, and executive functioning. Neurocognitive scores between time (pre- and post-operative) and within surgery characteristics (surgery type, side) were analyzed. Results:
There were no significant differences between pre- and post-operative performance on the neurocognitive measures with both groups combined. Scores for LITT were significantly different and superior to ATL postoperatively for immediate (F [1,18.25] = 5.27, p =.034) and delayed (F [1,18.46] = 12.78, p =.002) verbal story memory and immediate (F [1,21.65] = 7.44, p =.012) and delayed (F [1,21.98] = 4.39, p =.048) visual memory. Dominant hemisphere surgery was consistently associated with significantly lower scores across nearly all neurocognitive measures post-operatively.
Conclusions:
Consistent with previous literature, patients who underwent ATL showed worse performance on immediate and delayed memory measures post-operatively, regardless of laterality. Patients who underwent dominant hemisphere surgery, either ATL or LITT, showed worse performance across cognitive domains, including those not traditionally associated with left temporal functions (such as visual memory and executive functions). Findings suggest that LITT has less effect on specific types of memory than ATL, but more research is needed. Funding: None.