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Selective posterior cerebral artery amobarbital test: a predictor of memory following subtemporal selective amygdalohippocampectomy
  1. Joshua S Catapano,
  2. Alexander C Whiting,
  3. Derrick J Wang,
  4. Randall J Hlubek,
  5. Mohamed A Labib,
  6. Clinton D Morgan,
  7. Scott Brigeman,
  8. Vance L Fredrickson,
  9. Daniel D Cavalcanti,
  10. Kris A Smith,
  11. Andrew F Ducruet,
  12. Felipe C Albuquerque
  1. Department of Neurosurgery, Barrow Neurological Institute St. Joseph’s Hospital and Medical Center, Phoenix, Arizona, USA
  1. Correspondence to Dr Felipe C Albuquerque, Division of Neurological Surgery, Barrow Neurological Institute, Phoenix, AZ 85013, USA; neuropub{at}


Background 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.

Methods 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.

Results 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.

Conclusion 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.

  • selective posterior cerebral artery amobarbital test
  • subtemporal selective amygdalohippocampectomy
  • temporal lobe epilepsy

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  • Contributors Data collection: JSC, AW, DW, RH, ML, CM, SB. Study design: JSC, VLF, DDC, KS, AD, FCA. Manuscript writing and editing: JSC, AW, VLF, DDC, KS, AD.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement There are no additional data to share.

  • Correction notice Since this article was first published online, middle initials have been added to some author names and the corresponding author’s email address has been updated.

  • Patient consent for publication Not required.