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Predictors of individual visual memory decline after unilateral anterior temporal lobe resection

From the Departments of Neurosurgery (M.F.D., R.G.G.) and Neurology (A.V.), The Methodist Neurological Institute, Houston; and the Department of Neurosurgery (H.S.L., D.Y.), Baylor College of Medicine Comprehensive Epilepsy Center (H.S.L., M.K.Y., E.M.M., I.G., D.Y.), Department of Physical Medicine and Rehabilitation (H.S.L.), Department of Neurology (M.K.Y., E.M.M., I.G.), Peter Kellaway Section of Neurophysiology in Neurology (E.M.M., I.G.), and Department of Pediatric Neurology (E.M.M.), Baylor College of Medicine, Houston, TX.

Address correspondence and reprint requests to Dr. Mario F. Dulay, 6560 Fannin, Suite 944, Houston, TX 77030 mdulay{at}tmhs.org

Background: Different types of neuropsychological visual memory tasks have been created to quantify deficits associated with right hemisphere dysfunction. There are reports of visual memory impairment after right anterior temporal lobe resection (ATR) compared to left ATR for the processing of faces, abstract designs, and spatial locations, but there are also studies showing no between-group differences. One potential reason for the conflicting results is the use of group mean changes, which mask individual differences.

Methods: Proportions of individual subjects with decline, no change, or improvement in memory for spatial locations, abstract designs, and unfamiliar faces were evaluated in 83 individuals who underwent a standard ATR (47 right, 36 left) and were left hemisphere language dominant.

Results: Type of visual memory ability was an important factor as there were differential individual declines found for memory for spatial locations after right ATR compared to left ATR (27.3% vs 5.9%), but not memory for abstract designs or face memory. Logistic regression indicated that the odds of a spatial memory decline were six times higher for patients who underwent right ATR than left ATR.

Conclusions: Memory for spatial locations appears to be particularly vulnerable to decline when a patient undergoes right-anterior temporal lobe resection (ATR) and when the patient has better spatial memory before surgery. Results provide proportions of subjects with significant change to help clinicians and patients make better informed decisions about risks associated with undergoing right ATR.

Abbreviations: ANOVA = analysis of variance; ATR = anterior temporal lobe resection; BVRT = Benton Visual Retention Test; DCS-R = Diagnosticum für Cerebralschäden; NVSRT = Nonverbal Selective Reminding Test; RCI = Reliable Change Index; ROCFT = Rey-Osterrieth Complex Figure Test; VMI = Visual Memory Index; VR = Visual Reproduction; WMS-III = Wechsler Memory Scale-III; WRMTF = Warrington's Recognition Memory Test for Faces.

Supplemental data at www.neurology.org

Disclosure: The authors report no disclosures.

Received May 14, 2008. Accepted in final form February 26, 2009.