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Temporal lobe stimulation reveals anatomic distinction between auditory naming processes

From the Departments of Neurology (Drs. Hamberger and Seidel) and Neurological Surgery (Drs. Goodman and McKhann), College of Physicians and Surgeons, Columbia University, New York; and Department of Neurology (Dr. Perrine), New York University Medical Center; Dr. Seidel’s current address is Ortho–McNeil Pharmaceutical, Raritan, NJ; and Dr. Perrine’s current address is Long Island Jewish Medical Center, Queens, NY.

Address correspondence and reprint requests to Dr. Marla J. Hamberger, Neurological Institute, 710 W. 168 St., Box 100, New York, NY 10032; e-mail: mh61{at}columbia.edu

Background: Language errors induced by cortical stimulation can provide insight into function(s) supported by the area stimulated. The authors observed that some stimulation-induced errors during auditory description naming were characterized by tip-of-the-tongue responses or paraphasic errors, suggesting expressive difficulty, whereas others were qualitatively different, suggesting receptive difficulty. They hypothesized that these two response types reflected disruption at different stages of auditory verbal processing and that these "subprocesses" might be supported by anatomically distinct cortical areas.

Objective: To explore the topographic distribution of error types in auditory verbal processing.

Methods: Twenty-one patients requiring left temporal lobe surgery underwent preresection language mapping using direct cortical stimulation. Auditory naming was tested at temporal sites extending from 1 cm from the anterior tip to the parietal operculum. Errors were dichotomized as either "expressive" or "receptive." The topographic distribution of error types was explored.

Results: Sites associated with the two error types were topographically distinct from one another. Most receptive sites were located in the middle portion of the superior temporal gyrus (STG), whereas most expressive sites fell outside this region, scattered along lateral temporal and temporoparietal cortex.

Conclusions: Results raise clinical questions regarding the inclusion of the STG in temporal lobe epilepsy surgery and suggest that more detailed cortical mapping might enable better prediction of postoperative language decline. From a theoretical perspective, results carry implications regarding the understanding of structure–function relations underlying temporal lobe mediation of auditory language processing.

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