Critical role of the ventral temporal lobe in naming

Objective: Lexical retrieval deficits are characteristic of a variety of different neurological disorders. However, the exact substrates responsible for this are not known. We studied a large cohort of patients undergoing surgery in the dominant temporal lobe for medically intractable epilepsy (n = 95) to localize brain regions that were associated with anomia.Methods: We performed a multivariate voxel- based lesion- symptom mapping analysis to correlate surgical lesions within the temporal lobe with changes in naming ability. Additionally, we used a surface- based mixed-effects multilevel analysis to estimate group- level broadband gamma activity during naming across a subset of patients with electrocorticographic recordings and integrated these results with lesion- deficit findings.Results: We observed that ventral temporal regions, centered around the mid-dle fusiform gyrus, were significantly associated with a decline in naming. Furthermore, we found that the ventral aspect of temporal lobectomies was lin-early correlated to a decline in naming, with a clinically significant decline oc-curring once the resection extended 6 cm from the anterior tip of the temporal lobe on the ventral surface. On electrocorticography, the majority of these cortical regions were functionally active following visual processing. These loci coincide with the sites of susceptibility artifacts during echoplanar imaging, which may explain why this region has been previously underappreciated as the locus re-sponsible for postoperative naming deficits.Significance: Taken together, these data highlight the crucial contribution of the ventral temporal cortex in naming and its important role in the pathophysiology of anomia following temporal lobe resections. As such, surgical strategies should attempt to preserve this region to mitigate postoperative language deficits.