Intraoperative localization and preservation of reading in ventral occipitotemporal cortex

Resective surgery in language-dominant ventral occipitotemporal cortex (vOTC) carries the risk of causing impairment to reading. As it is not on the lateral surface, it is not easily accessible for intraoperative mapping and extensive stimulation mapping can be time consuming. Here we assess the feasibility of using task-based electrocorticography (ECoG) recordings intraoperatively to help guide stimulation mapping of reading in vOTC. In 11 patients undergoing extraoperative, intracranial seizure mapping we recorded induced broadband gamma activation (70 - 150 Hz) during a visual category localizer. Word-responsive cortex localized in this manner showed a high sensitivity (72%) to stimulation-induced reading deficits, and the confluence of ECoG and stimulation positive sites appears to demarcate the visual word form area. In two additional patients, with pathologies necessitating resections in language-dominant vOTC, task-based functional mapping was performed intraoperatively using subdural ECoG, alongside direct cortical stimulation. Cortical areas critical for reading were mapped and successfully preserved, while enabling pathological tissue to be completely removed. Data collection is possible in <3 minutes and initial intraoperative data analysis takes <3 minutes, allowing for rapid assessment of broad areas of cortex. Eloquent cortex in ventral visual cortex can be rapidly mapped intraoperatively using ECoG. This method acts to guide high-probability targets for stimulation, with limited patient participation, and can be used to avoid iatrogenic dyslexia following surgery.