{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,28]],"date-time":"2026-03-28T01:59:09Z","timestamp":1774663149276,"version":"3.50.1"},"reference-count":80,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","license":[{"start":{"date-parts":[[2025,12,1]],"date-time":"2025-12-01T00:00:00Z","timestamp":1764547200000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,12,1]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>The Wada test, an intracarotid amobarbital procedure, is the gold standard for preoperative evaluation of postoperative memory decline in patients with drug-resistant epilepsy. However, it has certain limitations including false negatives due to insufficient hippocampal inhibition and false positives due to extrahippocampal disorders such as aphasia. This study examined the utility of posterior cerebral artery (PCA) selective anesthesia for functional evaluation (SAFE) as an alternative approach to avoid aphasia and assessed its predictive value for postoperative verbal memory decline.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>The authors conducted a single-center retrospective study of patients with drug-resistant epilepsy between May 2018 and December 2023, who subsequently underwent PCA SAFE before anterior temporal lobe resection. The SAFE protocol includes comparable memory tasks before and immediately after anesthetic infusion. Preinfusion assessments established baseline memory function, whereas postinfusion assessments evaluated brain function under selective anesthesia. Patients were required to memorize 8 words, 8 pictures, and 5 figures. After the anesthetic effects subsided, recognition tasks were performed for all presented stimuli. The memory score was calculated by subtracting the number of recognized items encoded under anesthesia from the baseline. Word recognition represented verbal memory, whereas figure recognition represented visual memory. A memory score \u2265 2 points on the side of the epileptic focus or no difference between left and right PCA SAFE was classified as a high risk of postoperative memory decline. A decline of \u2265 15 points in postoperative memory scores on the Wechsler Memory Scale\u2013Revised was defined as significant memory decline.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>The authors included 11 patients (focus side: left in 8 patients and right in 3 patients). Five patients were classified as having a high risk and 6 as having a low risk for verbal memory decline. All 5 high-risk patients revealed significant postoperative verbal memory decline, whereas 5 of the 6 low-risk patients did not. The sensitivity was 83.3%, and the specificity was 100%. No patients had a significant decline in postoperative visual memory.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>PCA SAFE was shown to predict postoperative verbal memory decline with high accuracy. This study highlights the utility of PCA SAFE in reducing aphasic interference in verbal memory, leading to a more accurate evaluation of surgical candidacy in patients with drug-resistant epilepsy.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2025.8.jns25878","type":"journal-article","created":{"date-parts":[[2025,12,8]],"date-time":"2025-12-08T17:26:17Z","timestamp":1765214777000},"page":"1-8","source":"Crossref","is-referenced-by-count":1,"title":["Assessment of memory lateralization by posterior cerebral artery selective anesthesia and postoperative verbal memory decline"],"prefix":"10.3171","author":[{"given":"Hana","family":"Kikuchi","sequence":"first","affiliation":[{"name":"Department of Behavioral Neurology and Cognitive Neuroscience, Tohoku University Graduate School of Medicine, Sendai, Miyagi;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kazuo","family":"Kakinuma","sequence":"additional","affiliation":[{"name":"Department of Behavioral Neurology and Cognitive Neuroscience, Tohoku University Graduate School of Medicine, Sendai, Miyagi;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shin-Ichiro","family":"Osawa","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shoko","family":"Ota","sequence":"additional","affiliation":[{"name":"Department of Behavioral Neurology and Cognitive Neuroscience, Tohoku University Graduate School of Medicine, Sendai, Miyagi;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kazuto","family":"Katsuse","sequence":"additional","affiliation":[{"name":"Department of Behavioral Neurology and Cognitive Neuroscience, Tohoku University Graduate School of Medicine, Sendai, Miyagi;"},{"name":"Department of Neurology, Graduate School of Medicine, The University of Tokyo;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kazushi","family":"Ukishiro","sequence":"additional","affiliation":[{"name":"Department of Epileptology, Tohoku University Graduate School of Medicine, Sendai, Miyagi; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kazutaka","family":"Jin","sequence":"additional","affiliation":[{"name":"Department of Epileptology, Tohoku University Graduate School of Medicine, Sendai, Miyagi; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shiho","family":"Sato","sequence":"additional","affiliation":[{"name":"Department of Diagnostic Radiology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shunji","family":"Mugikura","sequence":"additional","affiliation":[{"name":"Department of Diagnostic Radiology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hidenori","family":"Endo","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nobukazu","family":"Nakasato","sequence":"additional","affiliation":[{"name":"Department of Epileptology, Tohoku University Graduate School of Medicine, Sendai, Miyagi; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kyoko","family":"Suzuki","sequence":"additional","affiliation":[{"name":"Department of Behavioral Neurology and Cognitive Neuroscience, Tohoku University Graduate School of Medicine, Sendai, Miyagi;"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"issue":"12","key":"b1","series-title":"Nat Rev Neurol","first-page":"669","article-title":"Pharmacoresistance and the role of surgery in difficult to treat epilepsy","volume":"8","author":"Wiebe S","year":"2012","unstructured":"Wiebe S, Jette N. Pharmacoresistance and the role of surgery in difficult to treat epilepsy. Nat Rev Neurol. 2012;8(12):669\u2013677."},{"issue":"2-3","key":"b2","series-title":"Epilepsy Res","first-page":"310","article-title":"Surgical outcomes in lesional and non-lesional epilepsy: a systematic review and meta-analysis","volume":"89","author":"T\u00e9llez-Zenteno JF","year":"2010","unstructured":"T\u00e9llez-Zenteno JF, Hern\u00e1ndez Ronquillo L, Moien-Afshari F, Wiebe S. Surgical outcomes in lesional and non-lesional epilepsy: a systematic review and meta-analysis. Epilepsy Res. 2010;89(2-3):310\u2013318."},{"issue":"3","key":"b3","series-title":"Neuropsychologia","first-page":"175","article-title":"Preface: material-specific and generalized memory loss","volume":"6","author":"Milner B","year":"1968","unstructured":"Milner B. Preface: material-specific and generalized memory loss. Neuropsychologia. 1968;6(3):175\u2013179."},{"issue":"1","key":"b4","series-title":"J Neurosurg","first-page":"101","article-title":"Verbal memory deficits after left temporal lobectomy for epilepsy: mechanism and intraoperative prediction","volume":"62","author":"Ojemann GA","year":"1985","unstructured":"Ojemann GA, Dodrill CB. Verbal memory deficits after left temporal lobectomy for epilepsy: mechanism and intraoperative prediction. J Neurosurg. 1985;62(1):101\u2013107."},{"issue":"3","key":"b5","series-title":"Epilepsia","first-page":"283","article-title":"Memory deficits after resection from left or right anterior temporal lobe in humans: a meta-analytic review","volume":"43","author":"Lee TMC","year":"2002","unstructured":"Lee TMC, Yip JTH, Jones-Gotman M. Memory deficits after resection from left or right anterior temporal lobe in humans: a meta-analytic review. 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Epilepsia. 2011;52(5):857\u2013869."},{"issue":"2","key":"b8","series-title":"J Neurosurg","first-page":"266","article-title":"Intracarotid injection of sodium amytal for the lateralization of cerebral speech dominance: experimental and clinical observations","volume":"17","author":"Wada J","year":"1960","unstructured":"Wada J, Rasmussen T. Intracarotid injection of sodium amytal for the lateralization of cerebral speech dominance: experimental and clinical observations. J Neurosurg. 1960;17(2):266\u2013282."},{"key":"b9","series-title":"Trans Am Neurol Assoc","first-page":"224","article-title":"Study of short-term memory after intracarotid injection of sodium amytal","volume":"87","author":"Milner B","year":"1962","unstructured":"Milner B, Branch C, Rasmussen T. Study of short-term memory after intracarotid injection of sodium amytal. 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Radiology. 2010;255(1):128\u2013134."},{"key":"b12","series-title":"Epilepsy Behav","first-page":"107065","article-title":"Concordance between fMRI and Wada test for memory lateralization in temporal lobe epilepsy: a meta-analysis and systematic review","volume":"107","author":"Massot-Tarr\u00fas A","year":"2020","unstructured":"Massot-Tarr\u00fas A, White KP, Mousavi SR, Hayman-Abello S, Hayman-Abello B, Mirsattari SM. Concordance between fMRI and Wada test for memory lateralization in temporal lobe epilepsy: a meta-analysis and systematic review. Epilepsy Behav. 2020;107:107065."},{"issue":"12","key":"b13","series-title":"Epilepsia","first-page":"2305","article-title":"Diagnostic accuracy of functional magnetic resonance imaging, Wada test, magnetoencephalography, and functional transcranial Doppler sonography for memory and language outcome after epilepsy surgery: a systematic review","volume":"59","author":"Schmid E","year":"2018","unstructured":"Schmid E, Thomschewski A, Taylor A,  Diagnostic accuracy of functional magnetic resonance imaging, Wada test, magnetoencephalography, and functional transcranial Doppler sonography for memory and language outcome after epilepsy surgery: a systematic review. Epilepsia. 2018;59(12):2305\u20132317."},{"key":"b14","series-title":"Clin Neurol Neurosurg","first-page":"107580","article-title":"WADA test for postoperative memory prediction in left TLE. 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Published online June 13, 2025. doi:10.3171\/2025.2.JNS242534"},{"issue":"1","key":"b28","series-title":"Brain Cogn","first-page":"71","article-title":"The anterior and posterior selective temporal lobe amobarbital tests: angiographic, clinical, electroencephalographic, PET, SPECT findings, and memory performance","volume":"33","author":"Wieser HG","year":"1997","unstructured":"Wieser HG, M\u00fcller S, Schiess R,  The anterior and posterior selective temporal lobe amobarbital tests: angiographic, clinical, electroencephalographic, PET, SPECT findings, and memory performance. 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