E-ISSN : 2733-4538
본 연구는 전측 측두엽 절제술의 기억 성과를 알아보고자 했다. 측두엽 절제 환자중 해마 경화가 확인되고 오른손잡이이며 지능이 70이상인 사례(우측두엽 21명, 좌측두엽 17명)를 대상으로 했다. 논리기억, 언어 연합학습, 도형재생, 시각 연합학습 등을 수술 2개월 전 시점과 수술 16개월 후 시점에서 각각 측정하였다. 다변량분석 결과, 수술부위(좌/우측두엽), 기억 재료(언어/시각 기억), 평가시기(수술 전/후), 그리고 성별의 사원상호작용이 유의미했다. 효과의 원천은 여자가 좌측두엽 절제후 언어기억이 향상되고, 남자는 우측두엽 수술 후 언어기억이 호전되는 양상에 있었다. 이는 수술 동측 반구의 재료 특정적 기억 저하, 대측 반구의 기능 해방 효과, 그리고 성차로서 여성에 특유한 언어기억의 높은 가소성이 상호작용해 기억변화의 양상을 결정함을 말해준다. 의외의 결과로, 수술 후에 기억이 전반적으로 호전되었는데(평가시기의 주효과), 기억 검사가 수술에 임박한 시점에서 고된 의학적 검사와 함께 이뤄져서 수술전 기억이 과소추정되었을 가능성을 논의하였다. 또한 수술후 기억 변화를 예측하는 추가적 변인을 탐색하였는데, 언어기억의 예측 변인은 수술시 연령이었다. 조기 수술일수록 기억의 예후가 좋았다. 반면 수술전 기억의 수준이나 발병 연령의 설명력은 유의하지 않았다. 한편 시각기억의 변화에 대한 분석에서는 어떤 예측 변인도 찾아지지 않았다. 시각기억 변화의 불확실성의 원인으로서 시각기억 검사의 타당도 문제를 논의했고, 위치 기억 과제를 대안으로 채용하는 방안을 제시했다.
The present study investigated the memory outcome of anterior temporal lobectomy(TL). 21 right and 17 left TL patients who passed the inclusion criteria(having confirmed hippocampal sclerosis, right-handed, older than 16 years, and full scale IQ higher than 69) performed logical memory, verbal paired associate, visual reproduction, and visual paired associate about 2 month before and 16 month after the surgery. In the MANOVA, four-way interaction among side of surgery(left/right), memory material(verbal/visual), phase(pre/post operation), and gender was significant. The source of effect was analyzed to locate in verbal memory improvement of women after left TL and that of men after right TL. It implies that material-specific memory decline in ipsilateral lobe, release of function in the contralateral lobe, and higher plasticity of verbal memory in women as a gender difference may interact to determine the pattern of memory change. In addition we explored the predicting variables of memory change. To the prediction of verbal memory change, age at operation made a significant contribution, but pre-operation memory level or age at onset did not. On the other hand, as for the visual memory we failed to find any predicting variable. To solve the null result from visual memory, a proposal to adopt the position memory task as an alternative measure was presented.
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