Cloppenborg Thomas, Mertens Markus, Hopf Johanna L, Kalbhenn Thilo, Bien Christian G, Woermann Friedrich G, Polster Tilman
Bielefeld University, Medical School, Department of Epileptology (Krankenhaus Mara), Bielefeld, Germany.
Society of Epilepsy Research, Bethel Epilepsy Centre, Bielefeld, Germany.
Epilepsy Behav. 2021 Sep 15;124:108274. doi: 10.1016/j.yebeh.2021.108274.
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.
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.
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.
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.
术前评估尚无既定常规方法来评估阅读能力以及识别重要的“不可切除”阅读区域。功能模型描述了位于优势侧枕颞叶腹侧皮质（vOTC）中梭状回中部的视觉词形区（VWFA）对阅读至关重要。我们证明了侵入性VWFA映射的相关性和可行性。
4例癫痫患者通过左侧颞底部条状电极进行侵入性VWFA映射。将结果与文献中的其他数据进行联合配准，从而定义一个感兴趣区域（ROI），以便通过对2004年至2018年间在该ROI进行切除手术的患者进行标准化电话访谈，对术后阅读缺陷进行回顾性评估。
皮质电刺激干扰了4例结构性癫痫患者的全词识别和阅读。刺激结果显示分布于颞叶底部（中脑背侧至枕前切迹）。我们确定了34例在优势半球ROI进行切除手术的患者。其中，15例（44.1%）出现术后阅读缺陷，平均持续时间为18.2个月（±32.4，0.5 - 122）。6例患者出现逐字母（LBL）阅读。2例患者在ROI切除术后出现永久性LBL阅读。
我们通过（1）对VWFA进行术中皮质刺激以及（2）对该区域手术患者阅读缺陷的回顾性病例研究，提供了vOTC对阅读功能相关性的证据。对于左侧vOTC有病变的患者，术前评估应包括阅读评估以及有关重要阅读结构的数据。
