Beth Rispoli¹ (), Tina Liu¹, Kyungji Moon¹, Radhika Chatterjee², Kareem Zaghloul², Sara Inati²; ¹Georgetown University Medical Center, ²National Institute of Neurological Disorders and Stroke

The visual word form area (VWFA), typically located in the left ventral temporal cortex (VTC), is crucial for word reading due to its privileged connectivity to higher-order visual, semantic, and language areas. While acute lesions involving the VWFA in adulthood can result in reading impairments (e.g., alexia), the impact of lesions to connected cortex on VWFA function remains unclear. In this study, we ask whether a resection of anterior temporal lobe (ATL) impacts reading selectivity in the VTC and how outcomes may vary by hemisphere of resection. We analyzed a clinical dataset of adult patients (n=9) who underwent surgical resection of ATL as a treatment for drug-resistant epilepsy. Patients completed an fMRI reading task both pre-operatively and one year post-operatively. During the reading task, patients read on-screen stories and viewed a matched control condition. VTC anatomical ROIs were drawn in the native space of each patient’s brain for each hemisphere, and mean responses for the reading and control conditions were computed. Reading selectivity was calculated in each ROI as the difference in beta weights between the reading and control conditions for each session. We found that the hemisphere of resection was predictive of a change in reading selectivity after surgery in the intact, homotopic VTC. Following left ATL resection (n=5), all patients showed a consistent increase in reading selectivity in the intact right VTC. Conversely, patients with right ATL resection (n=4) did not show this pattern, likely because language and reading functions remained lateralized to the left hemisphere. Together, these findings highlight the plasticity of reading-related circuitry in adulthood, showing that disruption of left hemisphere VWFA connectivity via ATL resection can promote compensatory reliance on the intact right VWFA. Importantly, this homotopic reorganization of the VWFA appears to be asymmetric, as no comparable reorganization occurs following right hemisphere ATL resection.