Function-specific high-probability "nodes" identified in posterior language cortex

Purpose: Posterior, "Wenicke's;" language areas have a high degree of betwe en-subject variability, as shown by electrical-stimulation mapping. We inve stigated the possibility of an organized structure in the distribution of p osterior language areas. Methods: Extraoperative subdural grid stimulation was performed on 67 left hemisphere-dominant patients before resective epilepsy surgery during count ing, naming, and reading. Intersubject-averaged language maps were generate d in which stimulation disrupted only one language function and not the oth ers, or combinations of language functions. Results: Language sites, although highly variable between subjects, were no t organized randomly and appeared to be arranged into several focal, non-co ntiguous, higher probability "nodes" devoted to different aspects of langua ge processing. Speech-arrest sites were concentrated in classic Wernicke's area. Areas where stimulation induced only reading errors were found in the posterior middle temporal gyrus and the inferior parietal lobule. These re gions may correspond with an orthographic input lexicon. Areas eliciting on ly naming errors were found in the posterior inferior temporal gyrus extend ing into the mid-middle temporal gyrus and may represent a visual-represent ation input lexicon. Sites where stimulation elicited errors in both naming and reading were more variable in location than sites devoted to only one function, extended farther anteriorly along the temporal neocortex, and may correspond with a semantic lexicon. Conclusions: The existence of high-probability nodes in posterior language cortex supports a modality-specific modular architecture and the possibilit y of a conserved, universal structure.