Purpose: Posterior, "Wenicke's," language areas have a high degree of between-subject variability, as shown by electrical-stimulation mapping. We investigated the possibility of an organized structure in the distribution of posterior language areas.
Methods: Extraoperative subdural grid stimulation was performed on 67 left hemisphere-dominant patients before resective epilepsy surgery during counting, naming, and reading. Intersubject-averaged language maps were generated in which stimulation disrupted only one language function and not the others, or combinations of language functions.
Results: Language sites, although highly variable between subjects, were not organized randomly and appeared to be arranged into several focal, non-contiguous, higher probability "nodes" devoted to different aspects of language 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 regions may correspond with an orthographic input lexicon. Areas eliciting only naming errors were found in the posterior inferior temporal gyrus extending into the mid-middle temporal gyrus and may represent a visual-representation 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 possibility of a conserved, universal structure.