Department of Neurosurgery, Barrow Neurological Institute St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
J Neurointerv Surg. 2020 Feb;12(2):165-169. doi: 10.1136/neurintsurg-2019-014984. Epub 2019 Jul 18.
The selective posterior cerebral artery (PCA) amobarbital test, or PCA Wada test, is used to predict memory impairment after epilepsy surgery in patients who have previously had a failed internal carotid artery (ICA) amobarbital test.
Medical records from 2012 to 2018 were retrospectively reviewed for all patients with seizures who underwent a selective PCA Wada test at our institution following a failed or inconclusive ICA Wada test. Standardized neuropsychological testing was performed before and during the Wada procedure and postoperatively in patients who underwent resection.
Thirty-three patients underwent a selective PCA Wada test, with no complications. Twenty-six patients with medically refractory epilepsy had a seizure focus amenable to selective amygdalohippocampectomy (AHE). Six patients (23%, n=26) had a failed PCA Wada test and did not undergo selective AHE, seven (27%) declined surgical resection, leaving 13 patients who underwent subtemporal selective AHE. Hippocampal sclerosis was found in all 13 patients (100%). Twelve patients (92%) subsequently underwent formal neuropsychological testing and all were found to have stable memory. Ten patients (77%) were seizure-free (Engel Class I), with average follow-up of 13 months.
The selective PCA Wada test is predictive of memory outcomes after subtemporal selective AHE in patients with a failed or inconclusive ICA Wada test. Furthermore, given the low risk of complications and potential benefit of seizure freedom, a selective PCA Wada test may be warranted in patients with medically intractable epilepsy who are candidates for a selective AHE and who have a prior failed or inconclusive ICA Wada test.
选择性大脑后动脉（PCA）戊巴比妥测试，或 PCA Wada 测试，用于预测曾行颈内动脉（ICA）戊巴比妥测试失败或结果不确定的癫痫患者手术后记忆障碍。
回顾性分析 2012 年至 2018 年在我院行选择性 PCA Wada 测试的所有癫痫患者的病历，这些患者在 ICA Wada 测试失败或结果不确定后进行了该测试。在 Wada 手术前、手术期间和手术后，对接受切除术的患者进行了标准化神经心理学测试。
33 例患者行选择性 PCA Wada 测试，无并发症。26 例药物难治性癫痫患者的致痫灶适合选择性杏仁核海马切除术（AHE）。6 例（23%，n=26）患者 PCA Wada 测试失败，未行选择性 AHE，7 例（27%）拒绝手术切除，13 例患者行颞叶选择性 AHE。13 例患者（100%）均发现海马硬化。12 例患者（92%）随后接受了正式的神经心理学测试，均发现记忆稳定。10 例患者（77%）无癫痫发作（Engel Ⅰ级），平均随访 13 个月。
对于 ICA Wada 测试失败或结果不确定的患者，选择性 PCA Wada 测试可预测颞叶选择性 AHE 后的记忆结果。此外，鉴于并发症风险低且有癫痫无发作的潜在获益，对于适合选择性 AHE 且有先前 ICA Wada 测试失败或结果不确定的药物难治性癫痫患者，可行选择性 PCA Wada 测试。
