Better object recognition and naming outcome withMRI‐guided stereotactic laser amygdalohippocampotomy for temporal lobe epilepsy

SummaryObjectivesPatients with temporal lobe epilepsy (TLE) experience significant deficits in category‐related object recognition and naming following standard surgical approaches. These deficits may result from a decoupling of core processing modules (e.g., language, visual processing, and semantic memory), due to “collateral damage” to temporal regions outside the hippocampus following open surgical approaches. We predicted that stereotactic laser amygdalohippocampotomy (SLAH) would minimize such deficits because it preserves white matter pathways and neocortical regions that are critical for these cognitive processes.MethodsTests of naming and recognition of common nouns (Boston Naming Test) and famous persons were compared with nonparametric analyses using exact tests between a group of 19 patients with medically intractable mesialTLEundergoingSLAH(10 dominant, 9 nondominant), and a comparable series ofTLEpatients undergoing standard surgical approaches (n = 39) using a prospective, nonrandomized, nonblinded, parallel‐group design.ResultsPerformance declines were significantly greater for the patients with dominantTLEwho were undergoing open resection versusSLAHfor naming famous faces and common nouns (F = 24.3, p < 0.0001, η2 = 0.57, and F = 11.2, p < 0.001, η2 = 0.39, respectively), and for the patients with nondominantTLEundergoing open resection versusSLAHfor recognizing famous faces (F = 3.9, p < 0.02,η2 = 0.19). When examined on an individual subject basis, noSLAHpatients experienced any performance declines on these measures. In contrast, 32 of the 39 patients undergoing standard surgical approaches declined on one or more measures for both object types (p < 0.001, Fisher's exact test). Twenty‐one of 22 left (dominant)TLEpatients declined on one or both naming tasks after open resection, while 11 of 17 right (nondominant)TLEpatients declined on face recognition.SignificancePreliminary results suggest (1) naming and recognition functions can be spared inTLEpatients undergoingSLAH, and (2) the hippocampus does not appear to be an essential component of neural networks underlying name retrieval or recognition of common objects or famous faces.