Diffusion tractography for awake craniotomy: accuracy and factors affecting specificity.

INTRODUCTION: Despite evidence of correspondence with intraoperative stimulation, there remains limited data on MRI diffusion tractography (DT)'s sensitivity to predict morbidity after neurosurgical oncology treatment. Our aims were: (1) evaluate DT against subcortical stimulation mapping and performance changes during and after awake neurosurgery; (2) evaluate utility of early post-operative DT to predict recovery from post-surgical deficits. METHODS: We retrospectively reviewed our first 100 awake neurosurgery procedures using DT- neuronavigation. Intra-operative stimulation and performance outcomes were assessed to classify DT predictions for sensitivity and specificity calculations. Post-operative DT data, available in 51 patients, were inspected for tract damage. RESULTS: 91 adult brain tumor patients (mean 49.2 years, 43 women) underwent 100 awake surgeries with subcortical stimulation between 2014 and 2019. Sensitivity and specificity of pre-operative DT predictions were 92.2% and 69.2%, varying among tracts. Post-operative deficits occurred after 41 procedures (39%), but were prolonged (> 3 months) in only 4 patients (4%). Post-operative DT in general confirmed surgical preservation of tracts. Post-operative DT anticipated complete recovery in a patient with supplementary motor area syndrome, and indicated infarct-related damage to corticospinal fibers associated with delayed, partial recovery in a second patient. CONCLUSIONS: Pre-operative DT provided very accurate predictions of the spatial location of tracts in relation to a tumor. As expected, however, the presence of a tract did not inform its functional status, resulting in variable DT specificity among individual tracts. While prolonged deficits were rare, DT in the immediate post-operative period offered additional potential to monitor neurological deficits and anticipate recovery potential.

Evidence for surface-based processing of binocular disparity.

It is convenient to think of an object's location as a point within a Cartesian framework; the x axis corresponds to right and left, the y axis to up and down, and the z axis to forward or backward. When an observer is looking straight ahead, binocular disparities provide information about distance along the z axis from the fixation plane. In this coordinate system, changes in disparity are treated as independent of changes in location along the orthogonal x and y axes. Does the human visual system use this three-dimensional coordinate system, or does it specify feature location in a coordinate frame determined by other nearby visible features? Here we show that the sensitivity of the human stereo system is determined by the distance of points with respect to a local reference plane, rather than by the distance along the z axis with respect to the fixation plane. There is a distinct advantage to using a local frame of reference for specifying location. It obviates the need to construct a complex three-dimensional space in either eye-centered or head-centered coordinates that must be updated with every shift of the eyes and head.