Linking Memory Impairment to Structural Connectivity in Extrahippocampal Temporal Lobe Epilepsy Surgery.

Objective: Temporal lobe epilepsy (TLE) constitutes the most common drug-refractory epilepsy syndrome. Tailored approaches are required, as TLE originates from extrahippocampal lesions in about one-quarter of surgical candidates. Despite high success rates in seizure control, concern persists regarding postoperative memory decline after lesionectomy. We investigated the associations between structural connectivity and postoperative memory performance in extrahippocampal TLE surgery.

Methods: In total, 55 patients (25 females, 30 males; mean age 29.8 ± 14.5 years; epilepsy duration 7.9 ± 10.5 years, 31 left, 24 right TLE) with extrahippocampal TLE undergoing hippocampal-sparing surgery were evaluated with standardized pre- and postoperative neuropsychological testing. Lesion volumes intersected with Human Connectome Project-derived tractography data were employed to assess the structural connectivity integrity via voxel-based and connectome-informed lesion-symptom mapping to identify cortical and white matter structures associated with cognitive outcomes.

Results: Post-surgery, the widespread structural disconnection of several major white matter pathways was found, correlating with verbal memory and delayed recall. Additionally, the structural disconnection of the ipsilateral temporal lobe white matter was further associated with hippocampal atrophy.

Conclusions: Our study highlights the role of structural connectivity alterations in postoperative memory decline in extrahippocampal TLE surgery. These findings expand the traditional understanding of hippocampal integrity in memory function towards the importance of broader structural networks. Individualized, connectome-informed surgical approaches might protect neurocognitive function.