Anatomic dissociation of auditory and visual naming in the lateral temporal cortex

Background and Objective: Visual object naming traditionally has been used to identify cortical areas essential for naming (i.e., word retrieval), and investigators have found critical naming sites in the middle and posterior temporal region in most patients. Based on clinical observation, empirical findings, and the pathophysiology of temporal lobe epilepsy, the authors hypothesized that naming sites identified from auditory cues might also be relevant, and that within the temporal region, these sites would be anatomically distinct and located anterior to naming sites based on visual cues. Methods: Twenty patients requiring resective surgery involving the left (language dominant) temporal lobe underwent pre-resection language mapping using direct cortical stimulation. Visual and auditory naming were tested at lateral temporal sites extending from 1 cm from the anterior tip to the parietal operculum. Results: Auditory naming was consistently disrupted by stimulation in the anterior temporal lobe, whereas both auditory and visual naming were impaired by stimulation in the posterior temporal region. Conclusions: This pattern may explain why word finding difficulties sometimes arise or worsen following surgical procedures in which the anterior temporal region is resected without language mapping, or when resection is based on mapping that identifies language cortex exclusively using visual tasks. These results suggest that utilization of auditory based naming tasks might improve pre-resection identification of essential language cortex during direct stimulation cortical mapping, as well as noninvasive localization of dysfunction during presurgical cognitive testing.