Differential effects of temporal pole resection with amygdalohippocampectomy versus selective amygdalohippocampectomy on material‐specific memory in patients with mesial temporal lobe epilepsy

Summary Purpose: In the surgical treatment of mesial temporal lobe epilepsy, there is converging evidence that individually tailored or selective approaches have a favorable cognitive outcome compared to standard resections. There is, however, also evidence that due to collateral damage, selective surgery can be less selective than suggested. As part of a prospective transregional research project the present study evaluated the outcome in memory and nonmemory functions, following two selective approaches: a combined temporal pole resection with amygdalohippocampectomy (TPR+) and transsylvian selective amygdalohippocampectomy (SAH). Methods: One year after surgery, cognitive outcomes of postoperatively seizure‐free patients with mesial TLE and hippocampal sclerosis, who underwent either TPR+ (N = 35) or SAH (N = 62) in two German epilepsy centers (Bonn/Berlin), were compared. Results: Repeated measurement MANOVA and separate post hoc testing indicated a double dissociation of verbal/figural memory outcome as dependent on side and type of surgery. Verbal memory outcome was worse after left‐sided operation, but especially for SAH, whereas figural memory outcome was worse after right‐sided operation, preferentially for TPR+. Attention improved independent of side or type of surgery, and language functions showed some improvement after right‐sided surgeries. Discussion: The results indicate a differential effect of left/right SAH versus TPR+ on material‐specific memory insofar as transsylvian SAH appears to be favorable in right and TPR+ in left MTLE. The different outcomes are discussed in terms of a different surgical affection of the temporal pole and stem, and different roles of these structures for verbal and figural memory.