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Selective posterior cerebral artery Amytal test for evaluating memory function before surgery for temporal lobe
C R Jack1, D A Nichols, F W Sharbrough
1Department of Diagnostic Radiology, Mayo Clinic, Rochester, MN 55905.
Radiology
|September 1, 1988
Summary
Selective memory testing using the posterior cerebral artery (PCA) offers advantages over the internal carotid artery (ICA) method. This modified Amytal test improves memory assessment for epilepsy surgery candidates.
Area of Science:
- Neurology
- Neurosurgery
- Diagnostic Imaging
Background:
- The Amytal test is crucial for assessing memory function before epilepsy surgery.
- The traditional internal carotid artery (ICA) injection method has limitations.
- Refractory temporal lobe epilepsy often requires surgical intervention.
Purpose of the Study:
- To evaluate a modified Amytal test using posterior cerebral artery (PCA) injection.
- To compare the efficacy and safety of PCA versus ICA Amytal testing.
- To assess the suitability of the PCA Amytal test for patients undergoing pre-surgical evaluation.
Main Methods:
- A Tracker catheter system was used for selective PCA injections.
- The modified test involved immediate memory testing post-injection.
- The study included 20 patients with refractory temporal lobe epilepsy.
Main Results:
- The PCA Amytal test was successfully completed in 17 out of 20 patients.
- The PCA technique allowed immediate memory testing at peak drug effect.
- Patients tested via PCA did not experience aphasia, even when the speech-dominant hemisphere was involved.
- PCA injection demonstrated more effective drug delivery to the ipsilateral hippocampal formation.
Conclusions:
- Selective PCA Amytal testing is a feasible and promising modification of the traditional ICA test.
- This technique overcomes key limitations of the ICA method, enhancing memory assessment.
- The PCA Amytal test is a valuable tool for pre-surgical evaluation in temporal lobe epilepsy patients.