Mani J, Diehl B, Piao Z, Schuele S S, Lapresto E, Liu P, Nair D R, Dinner D S, Lüders H O
University Hospitals-Case Medical Center, Department of Neurology, 11100 Euclid Avenue, Cleveland, OH 44106-5040, USA.
Neurology. 2008 Nov 11;71(20):1621-7. doi: 10.1212/01.wnl.0000334755.32850.f0.
Dejerine and Benson and Geschwind postulated disconnection of the dominant angular gyrus from both visual association cortices as the basis for pure alexia, emphasizing disruption of white matter tracts in the dominant temporooccipital region. Recently functional imaging studies provide evidence for direct participation of basal temporal and occipital cortices in the cognitive process of reading. The exact location and function of these areas remain a matter of debate.
To confirm the participation of the basal temporal region in reading.
Extraoperative electrical stimulation of the dominant hemisphere was performed in three subjects using subdural electrodes, as part of presurgical evaluation for refractory epilepsy.
Pure alexia was reproduced during cortical stimulation of the dominant posterior fusiform and inferior temporal gyri in all three patients. Stimulation resulted in selective reading difficulty with intact auditory comprehension and writing. Reading difficulty involved sentences and words with intact letter by letter reading. Picture naming difficulties were also noted at some electrodes. This region is located posterior to and contiguous with the basal temporal language area (BTLA) where stimulation resulted in global language dysfunction in visual and auditory realms. The location corresponded with the visual word form area described on functional MRI.
These observations support the existence of a visual language area in the dominant fusiform and occipitotemporal gyri, contiguous with basal temporal language area. A portion of visual language area was exclusively involved in lexical processing while the other part of this region processed both lexical and nonlexical symbols.
德热里纳、本森以及盖什温德推测，优势角回与双侧视联络皮层的联系中断是单纯性失读症的基础，强调优势颞枕区白质纤维束的破坏。最近的功能成像研究为颞叶基底和枕叶皮层直接参与阅读认知过程提供了证据。这些区域的确切位置和功能仍存在争议。
证实颞叶基底区域参与阅读。
作为难治性癫痫术前评估的一部分，对3名受试者使用硬膜下电极进行优势半球术中电刺激。
在所有3例患者中，优势后梭状回和颞下回皮层刺激期间均再现了单纯性失读症。刺激导致选择性阅读困难，听觉理解和书写正常。阅读困难涉及句子和单词，但逐字母阅读正常。在一些电极处也发现了图片命名困难。该区域位于颞叶基底语言区（BTLA）后方并与之相邻，在BTLA处进行刺激会导致视觉和听觉领域的整体语言功能障碍。该位置与功能磁共振成像所描述的视觉词形区相对应。
这些观察结果支持在优势梭状回和枕颞回中存在一个视觉语言区，与颞叶基底语言区相邻。视觉语言区的一部分专门参与词汇处理，而该区域的另一部分则处理词汇和非词汇符号。
