title: Selective posterior cerebral artery amobarbital test: its role in presurgical memory assessment in temporal lobe epilepsy.
abstract: OBJECTIVE
  To evaluate the efficacy and risk of complications of selective posterior cerebral artery (PCA) amobarbital anesthesia in memory assessment of patients with epilepsy under consideration for temporal lobe resection.
  
  
  METHODS
  Thirty-two candidates for temporal lobectomy in whom conclusive memory assessment could not be obtained by the standard intracarotid amobarbital procedure were submitted to a selective PCA amobarbital test. A mean dose of 75 mg amobarbital was injected via microcatheter into the P2 segment of the PCA. Ten common objects were presented for naming and remembering while the anesthesia was judged efficient. After return to neurologic baseline, recall and recognition memory were assessed.
  
  
  RESULTS
  In all of the 32 patients, angiography and PCA anesthesia were successfully accomplished without serious adverse events. All but one of the patients remained alert and cooperative for memory testing under the anesthesia, and 28 of these patients showed adequate memory capacity of the hemisphere contralateral to the side targeted for surgery. So far, 19 patients have proceeded to surgery, and no case of global amnesia or serious, material-specific memory impairment has resulted. Three patients failed the PCA test (fewer than 67% items correctly recognized) and were excluded from surgery, partly on the basis of the PCA test results, but also supported by an overall evaluation of all the diagnostic procedures used.
  
  
  CONCLUSIONS
  The selective PCA amobarbital test appears justifiable when performed by interventional neuroradiologists and may significantly reduce the risk of erroneously excluding patients with epilepsy from temporal resection. Further corroboration of the safety of the procedure seems warranted.
authors.affiliation: National Centre for Epilepsy, Sandvika, Norway. stabell@epilepsy.no
authors.forename: Kirsten E
authors.initials: KE
authors.lastname: Stabell
authors.forename: Søren J
authors.initials: SJ
authors.lastname: Bakke
authors.forename: Sverre
authors.initials: S
authors.lastname: Andresen
authors.forename: Helge
authors.initials: H
authors.lastname: Bjørnaes
authors.forename: Hans M
authors.initials: HM
authors.lastname: Borchgrevink
authors.forename: Paulina
authors.initials: P
authors.lastname: Due-Tønnessen
authors.forename: Einar
authors.initials: E
authors.lastname: Heminghyt
authors.forename: Terje
authors.initials: T
authors.lastname: Nome
authors.forename: Hans-Kristian
authors.initials: HK
authors.lastname: Pedersen
authors.forename: Jon
authors.initials: J
authors.lastname: Ramm-Pettersen
authors.forename: Geir K
authors.initials: GK
authors.lastname: Røste
authors.forename: Bjørn
authors.initials: B
authors.lastname: Tennøe
mesh_terms: D000293:Adolescent; D000328:Adult; D000654:Amobarbital / Q000494:pharmacology; D001921:Brain / Q000187:drug effects / Q000503:physiopathology*; D001931:Brain Mapping; D003072:Cognition Disorders / Q000175:diagnosis / Q000517:prevention & control; D004833:Epilepsy, Temporal Lobe / Q000175:diagnosis / Q000503:physiopathology* / Q000601:surgery*; D005260:Female; D007839:Functional Laterality / Q000187:drug effects* / Q000502:physiology; D006801:Humans; D006993:Hypnotics and Sedatives / Q000494:pharmacology; D007802:Language; D008297:Male; D008568:Memory / Q000187:drug effects*; D008875:Middle Aged; D009483:Neuropsychological Tests; D009485:Neuroradiography / Q000379:methods; D018579:Patient Selection; D020769:Posterior Cerebral Artery; D011183:Postoperative Complications / Q000175:diagnosis / Q000517:prevention & control; D011300:Preoperative Care; D015642:Radiology, Interventional / Q000379:methods; D013702:Temporal Lobe / Q000187:drug effects / Q000503:physiopathology / Q000601:surgery*
chemical_list: D006993:Hypnotics and Sedatives; D000654:Amobarbital