Electrocorticographic functional mapping identifies human cortex critical for auditory and visual naming

More comprehensive, and efficient, mapping strategies are needed to avoid post-operative language impairments in patients undergoing epilepsy surgery. Conservative resection of dominant anterior frontal or temporal cortex frequently results in post-operative naming deficits despite standard pre-operative electrocortical stimulation mapping of visual object (picture) naming. Naming to auditory description may better simulate word retrieval in human conversation but is not typically tested, in part due to the time demands of electrocortical stimulation mapping. Electrocorticographic high gamma (60-150. Hz) activity, recorded simultaneously through the same electrodes used for stimulation mapping, has recently been used to map brain function more efficiently, and has at times predicted deficits not anticipated based on stimulation mapping alone. The present study investigated electrocorticographic mapping of visual object naming and auditory descriptive naming within conservative dominant temporal or frontal lobe resection boundaries in 16 patients with 933 subdural electrodes implanted for epilepsy surgery planning. A logistic regression model showed that electrodes within traditional conservative dominant frontal or temporal lobe resection boundaries were significantly more likely to record high gamma activity during auditory descriptive naming than during visual object naming. Eleven patients ultimately underwent resection and 7 demonstrated post-operative language deficits not anticipated based on electrocortical stimulation mapping alone. Four patients with post-operative deficits underwent a resection that included sites where high gamma activity was observed during naming. These findings indicate that electrocorticographic mapping of auditory descriptive naming may reduce the risk of permanent post-operative language deficits following dominant temporal or frontal resection.