Objective

Presurgical evaluation has no established routine to assess reading competence and to identify essential “not to resect” reading areas. Functional models describe a visual word form area (VWFA) located in the midfusiform gyrus in the dominant ventral occipito-temporal cortex (vOTC) as essential for reading. We demonstrate the relevance and feasibility of invasive VWFA-mapping.

Methods

Four patients with epilepsy received invasive VWFA-mapping via left temporo-basal strip-electrodes. Co-registration of the results and additional data from the literature led to the definition of a region of interest (ROI) for a retrospective assessment of postoperative reading deficits by a standardized telephone-interview in patients with resections in this ROI between 2004 and 2018.

Results

Electrical cortical stimulation disturbed whole word recognition and reading in four patients with structural epilepsy. Stimulation results showed distribution in the basal temporal lobe (dorsal mesencephalon to preoccipital notch). We identified 34 patients with resections in the ROI of the dominant hemisphere. Of these, 15 (44.1%) showed a postoperative reading deficit with a mean duration of 18.2 months (+/−32.4, 0.5–122). Six patients suffered from letter-by-letter (LBL) reading. Two patients had permanent LBL reading after resection in the ROI.

Significance

We present evidence on the functional relevance of the vOTC for reading by (1) extra-operative cortical stimulation of the VWFA and by (2) a retrospective case study of reading deficits in patients operated in this area. Reading assessments and data concerning essential reading structures should be included in the presurgical evaluation of patients with lesions in the left vOTC.

中文翻译：

---

阅读和视觉词形区 (VWFA) – 一家癫痫外科中心的管理和临床经验

客观的

术前评估没有既定的常规来评估阅读能力和确定重要的“不要切除”阅读区域。功能模型描述了位于主要腹侧枕颞皮层 (vOTC) 中梭状回中的视觉词形区域 (VWFA) 作为阅读的必要条件。我们证明了侵入性 VWFA 映射的相关性和可行性。

方法

四名癫痫患者通过左侧颞基底条状电极接受了侵入性 VWFA 测绘。结果和文献中的其他数据的共同注册导致了感兴趣区域 (ROI) 的定义，用于通过标准化电话访谈对 2004 年至 2018 年期间在该 ROI 中切除的患者进行术后阅读缺陷的回顾性评估。

结果

皮层电刺激干扰了四名结构性癫痫患者的全字识别和阅读。刺激结果显示分布于基底颞叶（背中脑至枕前切迹）。我们确定了 34 名在优势半球的 ROI 中进行了切除的患者。其中，15 人 (44.1%) 出现术后阅读障碍，平均持续时间为 18.2 个月 (+/-32.4, 0.5-122)。六名患者患有逐字阅读（LBL）。两名患者在 ROI 切除后具有永久性 LBL 读数。

意义

我们通过 (1) VWFA 的手术外皮层刺激和 (2) 对在该区域手术的患者阅读缺陷的回顾性案例研究，提供了关于 vOTC 与阅读功能相关性的证据。阅读评估和有关基本阅读结构的数据应包括在左侧 vOTC 病变患者的术前评估中。