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Catapano JS, Whiting AC, Wang DJ, Hlubek RJ, Labib MA, Morgan CD, Brigeman S, Fredrickson VL, Cavalcanti DD, Smith KA, Ducruet AF, Albuquerque FC. Selective posterior cerebral artery amobarbital test: a predictor of memory following subtemporal selective amygdalohippocampectomy. J Neurointerv Surg 2019; 12:165-169. [PMID: 31320550 DOI: 10.1136/neurintsurg-2019-014984] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 06/10/2019] [Accepted: 06/24/2019] [Indexed: 11/03/2022]
Abstract
BACKGROUND The selective posterior cerebral artery (PCA) amobarbital test, or PCA Wada test, is used to predict memory impairment after epilepsy surgery in patients who have previously had a failed internal carotid artery (ICA) amobarbital test. METHODS Medical records from 2012 to 2018 were retrospectively reviewed for all patients with seizures who underwent a selective PCA Wada test at our institution following a failed or inconclusive ICA Wada test. Standardized neuropsychological testing was performed before and during the Wada procedure and postoperatively in patients who underwent resection. RESULTS Thirty-three patients underwent a selective PCA Wada test, with no complications. Twenty-six patients with medically refractory epilepsy had a seizure focus amenable to selective amygdalohippocampectomy (AHE). Six patients (23%, n=26) had a failed PCA Wada test and did not undergo selective AHE, seven (27%) declined surgical resection, leaving 13 patients who underwent subtemporal selective AHE. Hippocampal sclerosis was found in all 13 patients (100%). Twelve patients (92%) subsequently underwent formal neuropsychological testing and all were found to have stable memory. Ten patients (77%) were seizure-free (Engel Class I), with average follow-up of 13 months. CONCLUSION The selective PCA Wada test is predictive of memory outcomes after subtemporal selective AHE in patients with a failed or inconclusive ICA Wada test. Furthermore, given the low risk of complications and potential benefit of seizure freedom, a selective PCA Wada test may be warranted in patients with medically intractable epilepsy who are candidates for a selective AHE and who have a prior failed or inconclusive ICA Wada test.
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Affiliation(s)
- Joshua S Catapano
- Department of Neurosurgery, Barrow Neurological Institute St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Alexander C Whiting
- Department of Neurosurgery, Barrow Neurological Institute St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Derrick J Wang
- Department of Neurosurgery, Barrow Neurological Institute St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Randall J Hlubek
- Department of Neurosurgery, Barrow Neurological Institute St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Mohamed A Labib
- Department of Neurosurgery, Barrow Neurological Institute St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Clinton D Morgan
- Department of Neurosurgery, Barrow Neurological Institute St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Scott Brigeman
- Department of Neurosurgery, Barrow Neurological Institute St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Vance L Fredrickson
- Department of Neurosurgery, Barrow Neurological Institute St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Daniel D Cavalcanti
- Department of Neurosurgery, Barrow Neurological Institute St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Kris A Smith
- Department of Neurosurgery, Barrow Neurological Institute St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Andrew F Ducruet
- Department of Neurosurgery, Barrow Neurological Institute St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Felipe C Albuquerque
- Department of Neurosurgery, Barrow Neurological Institute St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
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