Brain Advance Access originally published online on August 18, 2005
Brain 2005 128(11):2742-2749; doi:10.1093/brain/awh621
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Brain stimulation reveals critical auditory naming cortex
1 Department of Neurology and 2 Department of Neurological Surgery, College of Physicians and Surgeons, Columbia University and 3 Department of Neurological Surgery, Weill Medical College of Cornell University, New York, NY and 4 Cephalon, Inc., West Chester, PA, USA
Correspondence to: Marla J. Hamberger, Ph.D., The Neurological Institute, 710 West 168th Street, Box 100, New York, NY 10032, USA E-mail: mh61{at}columbia.edu
One challenge in dominant temporal lobe epilepsy surgery is to remove sufficient epileptogenic tissue without compromising post-operative language functioning. Pre-resection electrical stimulation mapping enables identification of language areas that can be spared from resection, and also provides a unique opportunity to investigate brain–language relationships. Visual object naming is the gold standard for identifying ‘essential’ language cortex; however, sparing visual naming (VN) sites has not reliably prevented post-operative language decline. In addition to visual object naming, we included a more ‘ecologically valid’ auditory description naming task in our pre-resection cortical mapping protocol. Of the seven patients who had auditory naming (AN) sites removed, six declined post-operatively, whereas of the 12 patients who did not have AN sites removed, only 3 declined post-operatively (P = 0.02), suggesting an association between AN site removal and post-operative naming decline. Interestingly, although VN sites were preserved in all patients, AN site removal resulted in decline in both auditory and VN tasks. These findings not only have potentially critical clinical significance, but also argue for modality specificity, with considerable integration within the semantic system.
Key Words: language mapping; naming; cortical stimulation
Abbreviations: AN = auditory naming; ANT = auditory naming test; MTS = medial temporal sclerosis; RCI = reliable change index; TLE = temporal lobe epilepsy; TOT = tip-of-the-tongue; VN = visual naming; VNT = visual naming test
Received May 26, 2005. Revised July 8, 2005. Accepted July 26, 2005.
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