Successful Reorganization of Category-Selective Visual Cortex following Occipito-temporal Lobectomy in Childhood

Investigations of functional (re)organization in children who have undergone large cortical resections offer a unique opportunity to elucidate the nature and extent of cortical plasticity. We report findings from a 3-year investigation of a child, U.D., who underwent surgical removal of the right occipital and posterior temporal lobes at age 6 years 9 months. Relative to controls, post-surgically, U.D. showed age-appropriate intellectual performance and visuoperceptual face and object recognition skills. Using fMRI at five different time points, we observed a persistent hemianopia and no visual field remapping. In category-selective visual cortices, however, object- and scene-selective regions in the intact left hemisphere were stable early on, but regions subserving face and word recognition emerged later and evinced competition for cortical representation. These findings reveal alterations in the selectivity and topography of category-selective regions when confined to a single hemisphere and provide insights into dynamic functional changes in extrastriate cortical architecture. Liu et al. present longitudinal behavioral and neuroimaging evidence tracking the development of and dynamic competition between face and word processing in a single (left) hemisphere following right occipito-temporal lobectomy in a young child. Normal intermediate and complex perception was evident, attesting to functional plasticity in the higher-order visual cortex.