Reconstruction of a Submandibular Soft Tissue Defect with a Temporoparietal Fasciocutaneous Flap - A Case Report.

Rationale: Reconstruction of soft tissue defects in the facial region have always been challenging. Appropriate selection of flaps will result in minimal morbidity and restore the tissue form without compromising function. Patient Concerns: During reconstruction in the facial region, patients desire to have minimal visible scar and functions of the jaw bone. Diagnosis: The article discusses a case of right space infection with soft tissue loss in the submandibular region. Treatment: The fascial spaces were explored and the odontogenic foci of infection were removed. The soft tissue defect in the submandibular region was resurfaced using the temporoparietal fasciocutaneous flap. Outcomes: The flap was well settled, and facial contours were maintained with reasonable facial symmetry. Take-away Lessons: Surgical skill in the management of soft tissue defects in the fascial region demands sound knowledge of the facial region, selection of the flap and meticulous execution of the surgical plan.

The neural structures of theory of mind are valence-sensitive: evidence from three tDCS studies.

Several cortical structures are involved in theory of mind (ToM), including the dorsolateral prefrontal cortex (dlPFC), the ventromedial prefrontal cortex (vmPFC), and the right temporo- parietal junction (rTPJ). We investigated the role of these regions in mind reading with respect to the valence of mental states. Sixty-five healthy adult participants were recruited and received transcranial direct current stimulation (tDCS) (1.5 mA, 20 min) with one week interval in three separate studies. The stimulation conditions were anodal tDCS over the dlPFC coupled with cathodal tDCS over the vmPFC, reversed stimulation conditions, and sham in the first study, and anodal tDCS over the vmPFC, or dlPFC, and sham stimulation, with an extracranial return electrode in the second and third study. During stimulation, participants underwent the reading mind from eyes/voice tests (RMET or RMVT) in each stimulation condition. Anodal left dlPFC/cathodal right vmPFC stimulation increased the accuracy of negative mental state attributions, anodal rTPJ decreased the accuracy of negative and neutral mental state attributions, and decreased the reaction time of positive mental state attributions. Our results imply that the neural correlates of ToM are valence-sensitive.

Cerebellum and social abilities: A structural and functional connectivity study in a transdiagnostic sample.

The cerebellum has been involved in social abilities and autism. Given that the cerebellum is connected to the cortex via the cerebello-thalamo-cortical loop, the connectivity between the cerebellum and cortical regions involved in social interactions, that is, the right temporo-parietal junction (rTPJ) has been studied in individuals with autism, who suffer from prototypical deficits in social abilities. However, existing studies with small samples of categorical, case-control comparisons have yielded inconsistent results due to the inherent heterogeneity of autism, suggesting that investigating how clinical dimensions are related to cerebellar-rTPJ functional connectivity might be more relevant. Therefore, our objective was to study the functional connectivity between the cerebellum and rTPJ, focusing on its association with social abilities from a dimensional perspective in a transdiagnostic sample. We analyzed structural magnetic resonance imaging (MRI) and functional MRI (fMRI) scans obtained during naturalistic films watching from a large transdiagnostic dataset, the Healthy Brain Network (HBN), and examined the association between cerebellum-rTPJ functional connectivity and social abilities measured with the social responsiveness scale (SRS). We conducted univariate seed-to-voxel analysis, multivariate canonical correlation analysis (CCA), and predictive support vector regression (SVR). We included 1404 subjects in the structural analysis (age: 10.516 ± 3.034, range: 5.822-21.820, 506 females) and 414 subjects in the functional analysis (age: 11.260 ± 3.318 years, range: 6.020-21.820, 161 females). Our CCA model revealed a significant association between cerebellum-rTPJ functional connectivity, full-scale IQ (FSIQ) and SRS scores. However, this effect was primarily driven by FSIQ as suggested by SVR and univariate seed-to-voxel analysis. We also demonstrated the specificity of the rTPJ and the influence of structural anatomy in this association. Our results suggest that there is a complex relationship between cerebellum-rTPJ connectivity, social performance and IQ. This relationship is specific to the cerebellum-rTPJ connectivity, and is largely related to structural anatomy in these two regions. PRACTITIONER POINTS: We analyzed cerebellum-right temporoparietal junction (rTPJ) connectivity in a pediatric transdiagnostic sample. We found a complex relationship between cerebellum and rTPJ connectivity, social performance and IQ. Cerebellum and rTPJ functional connectivity is related to structural anatomy in these two regions.

Aesthetic Temporal Augmentation with the Pedicled Temporoparietal Fascia Flap.

INDRODUCTION: The contour of the temple area can significantly influence the overall facial shape and proportions. To date, various methods and techniques have been used to augment the deficient temporal fossa; however, each of these approaches has certain inherent limitations. The present study aimed to transfer the temporoparietal fascia flap (TPFF) to the frontotemporal regions for aesthetic temporal augmentation. METHODS: This was a retrospective study of 13 cases with temporal depression who underwent a TPFF procedure for aesthetic temporal augmentation. These cases were operated for three years, from January 1, 2020, to December 1, 2023, at Nanjing Second Hospital, Nanjing, China. RESULTS: The data of bilateral temple width showed a measurement of 12.20 ± 0.53 cm (preoperative) and 14.36 ± 0.41 cm (postoperative), with a statistically significant difference (p < 0.001). There were no postoperative complications, including hematomas, infection, or facial nerve injuries. All patients were followed for 6 to 48 months (mean: 18 months) and exhibited cosmetic improvement. Overall, 10 patients were satisfied with the aesthetic results, while 3 were unsatisfied due to undercorrected depression. During the follow-up period, the temple volume was maintained. The frontal temple exhibited a smooth contour, and scalp baldness at the incision site was inconspicuous. CONCLUSIONS: Compared with other methods, the pedicled TPFF flap transfer is a safe and effective technique for correcting depressions in the frontotemporal regions. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors. www.springer.com/00266 .

Identifying the Shared and Dissociable Neural Bases between Self-Worth and Moral Ambivalence.

Self-ambivalence, a prevalent phenomenon in daily life, has been increasingly substantiated by research. It refers to conflicting self-views and evaluations, primarily concerning self-worth and morality. Previous behavioral research has distinguished self-worth and moral ambivalence, but it remains unclear whether they have separable neural bases. The present study addressed this question by examining resting-state brain activity (i.e., the fractional amplitude of low-frequency fluctuations, fALFF) and connectivity (i.e., resting-state functional connectivity, RSFC) in 112 college students. The results found that self-worth ambivalence was positively related to the fALFF in the orbitofrontal cortex (OFC) and left superior parietal lobule (SPL). The RSFC strength between the SPL and precuneus/posterior cingulate cortex (PCC) was positively related to self-worth ambivalence. Moral ambivalence was positively associated with the fALFF in the left SPL (extending into the temporoparietal junction) and right SPL. The RSFC strengths between the left SPL/TPJ and OFC, as well as the RSFC strengths between the right SPL as a seed and the bilateral middle and inferior temporal gyrus, were associated with moral ambivalence. Overall, the neural bases of self-worth and moral ambivalence are associated with the SPL and OFC, involved in attentional alertness and value representation, respectively. Additionally, the neural basis of moral ambivalence is associated with the TPJ, responsible for mentalizing.

Improving mentalizing deficits in older age with region-specific transcranial direct current stimulation.

Older adults have difficulties to detect the intentions, thoughts, and feelings of others, indicating an age-associated decline of socio-cognitive abilities that are known as "mentalizing". These deficits in mental state recognition are driven by neurofunctional alterations in brain regions that are implicated in mentalizing, such as the right temporo-parietal junction (rTPJ) and the dorso-medial prefrontal cortex (dmPFC). We tested whether focal transcranial current stimulation (tDCS) of the rTPJ and dmPFC has the potential to eliminate mentalizing deficits in older adults. Mentalizing deficits were assessed with a novel mindreading task that required the recognition of mental states in child faces. Older adults (n = 60) performed worse than younger adults (n = 30) on the mindreading task, indicating age-dependent deficits in mental state recognition. These mentalizing deficits were ameliorated in older adults who received sham-controlled andodal tDCS over the rTPJ (n = 30) but remained unchanged in older adults who received sham-controlled andodal tDCS over the dmPFC (n = 30). We, thus, showed for the first time that anodal tDCS over the rTPJ has the potential to remediate age-dependent mentalizing deficits in a region-specific way. This provides a rationale for exploring stimulation-based interventions targeting mentalizing deficits in older age.

Moral decision-making in context: Behavioral and neural processes underlying allocations based on need, merit, and equality.

How to fairly allocate goods is a key issue of social decision-making. Extensive research demonstrates that people do not selfishly maximize their own benefits, but instead also consider how others are affected. However, most accounts of the psychological processes underlying fairness-related behavior implicitly assume that assessments of fairness are somewhat stable. In this paper, we present results of a novel task, the Re-Allocation Game, in which two players receive an allocation determined by the computer and, on half of the trials, one player has the subsequent possibility to change this allocation. Importantly, prior to the receipt of the allocation, players were shown either their respective financial situations, their respective performance on a previous simple task, or random information, while being scanned using functional neuroimaging. As expected, our results demonstrate when given the opportunity, participants allocated on average almost half the money to anonymous others. However, our findings further show that participants used the provided information in a dynamic manner, revealing the underlying principle based on which people re-allocate money - namely based on merit, need, or equality - switches dynamically. On the neural level, we identified activity in the right and left dorsolateral prefrontal cortices related to context-independent inequity and context-dependent fairness information respectively when viewing the computer-generated allocations. At the same time, activity in the temporoparietal and precuneus represented these different types of fairness-related information in adjacent and partially overlapping clusters. Finally, we observed that the activity pattern in the precuneus and putamen was most clearly related to participants' subsequent re-allocation decisions. Together, our findings suggest that participants judge an allocation as fair or unfair using a network associated with cognitive control and theory-of-mind, while dynamically switching between what might constitute a fair allocation in a particular context.

Exploring the transformative potential of out-of-body experiences: A pathway to enhanced empathy.

Out-of-body experiences (OBEs) are subjective phenomena during which individuals feel disembodied or perceive themselves as outside of their physical bodies, often resulting in profound and transformative effects. In particular, experiencers report greater heightened pro-social behavior, including more peaceful relationships, tolerance, and empathy. Drawing parallels with the phenomenon of ego dissolution induced by certain psychedelic substances, we explore the notion that OBEs may engender these changes through ego dissolution, which fosters a deep-seated sense of unity and interconnectedness with others. We then assess potential brain mechanisms underlying the link between OBEs and empathy, considering the involvement of the temporoparietal junction and the Default Mode Network. This manuscript offers an examination of the potential pathways through which OBEs catalyze empathic enhancement, shedding light on the intricate interplay between altered states of consciousness and human empathy.

The disengagement deficit after right-hemisphere damage: Distinct roles of lateral frontal and parietal damage.

An influential model of spatial attention postulates three main attention-orienting mechanisms: disengagement, shifting, and engagement. Early research linked disengagement deficits with superior parietal damage, regardless of hemisphere or presence of spatial neglect. Subsequent studies supported the involvement of more ventral parietal regions, especially in the right hemisphere, and linked spatial neglect to deficient disengagement from ipsilateral cues. However, previous lesion studies faced serious limitations, such as small sample sizes and the lack of brain-injured controls without neglect. Additionally, some studies employed symbolic cues or used long cue-target intervals, which may fail to reveal impaired disengagement. We here used a machine-learning approach to conduct lesion-symptom mapping (LSM) on 89 patients with focal cerebral lesions to the left (LH) or right (RH) cerebral hemisphere. A group of 54 healthy participants served as controls. The paradigm used to uncover disengagement deficits employed non-predictive cues presented in the visual periphery and at short cue-target intervals, targeting exogenous attention. The main factors of interest were group (healthy participants, LH, RH), target position (left, right hemifield) and cue validity (valid, invalid). LSM-analyses were performed on two indices: the validity effect, computed as the absolute difference between reaction times (RTs) following invalid compared to valid cues, and the disengagement deficit, determined by the difference between contralesional and ipsilesional validity effects. While LH patients showed general slowing of RTs to contralesional targets, only RH patients exhibited a disengagement deficit from ipsilesional cues. LSM associated the validity effect with a right lateral frontal cluster, which additionally affected subcortical white matter of the right arcuate fasciculus, the corticothalamic pathway, and the superior longitudinal fasciculus. In contrast, the disengagement deficit was related to damage involving the right temporoparietal junction. Thus, our results support the crucial role of right inferior parietal and posterior temporal regions for attentional disengagement, but also emphasize the importance of lateral frontal regions, for the reorienting of attention.

Magnetic Resonance Imaging after Nasopharyngeal Endoscopic Resection and Skull Base Reconstruction.

Background: Postoperative imaging after nasopharyngeal endoscopic resection (NER) and skull base reconstruction is quite challenging due to the complexity of the post-surgical and regional anatomy. Methods: In this retrospective observational study, we included patients treated with NER from 2009 to 2019 and submitted to Magnetic Resonance Imaging (MRI) 6 and 12 months after surgery. A radiologist with 15 years of experience analyzed all MRI scans. Results: A total of 50 patients were considered in this study, 18 of whom were excluded due to imaging unavailability, and 16 of whom were not considered due to major complications and/or persistent disease. Sixteen patients were evaluated to identify the expected findings. Inflammatory changes were observed in 16/64 subsites, and regression of these changes was observed in 8/64 at 1 year. Fibrosis was observed in 5/64 subsites and was unmodified at 1 year. The nasoseptal flap showed homogeneous enhancement at 6 months (100%) and at 1 year. The temporo-parietal fascia flap (TPFF) showed a decrease in the T2- signal intensity of the mucosal layer in 57% of the patients at 1 year and a decrease in enhancement in 43%. Conclusions: Identifying the expected findings after NER and skull base reconstruction has a pivotal role in the identification of complications and recurrence.

Temporoparietal Flap for Facial Reconstruction: Donor Site Morbidity.

Background: Temporoparietal flap (TPF) is recommended when thin delicate tissue for medium sized defect is needed. The most used form of this flap is for auricle reconstruction. In this article usage of this flap for facial reconstruction other than auricle is discussed, emphasing on donor site morbidity. Method: In this retrospective study, archived files of the Department of Oral and Maxillofacial Surgery, University of Medical Sciences, Mashhad, Iran were evaluated from 2016-2020. Patients whom TPF was used for facial reconstruction were included. Flap survival was checked and donor site morbidity was evaluated in the form of skin scar and frontal nerve branch injury. Results: This flap was used in 8 patients for facial reconstruction. All the cases had experienced Alopecia and this was the greatest when the skin of scalp was also included. All of the patients could elevate the eyebrow that means intact frontal branch of facial nerve. Conclusion: TPF is a versatile flap for facial reconstruction. However, alopecia is high in composite fasciocutaneous form of this flap.

Neural mechanisms underlying improved new-word learning with high-density transcranial direct current stimulation.

Neurobehavioral studies have provided evidence for the effectiveness of anodal tDCS on language production, by stimulation of the left Inferior Frontal Gyrus (IFG) or of left Temporo-Parietal Junction (TPJ). However, tDCS is currently not used in clinical practice outside of trials, because behavioral effects have been inconsistent and underlying neural effects unclear. Here, we propose to elucidate the neural correlates of verb and noun learning and to determine if they can be modulated with anodal high-definition (HD) tDCS stimulation. Thirty-six neurotypical participants were randomly allocated to anodal HD-tDCS over either the left IFG, the left TPJ, or sham stimulation. On day one, participants performed a naming task (pre-test). On day two, participants underwent a new-word learning task with rare nouns and verbs concurrently to HD-tDCS for 20 min. The third day consisted of a post-test of naming performance. EEG was recorded at rest and during naming on each day. Verb learning was significantly facilitated by left IFG stimulation. HD-tDCS over the left IFG enhanced functional connectivity between the left IFG and TPJ and this correlated with improved learning. HD-tDCS over the left TPJ enabled stronger local activation of the stimulated area (as indexed by greater alpha and beta-band power decrease) during naming, but this did not translate into better learning. Thus, tDCS can induce local activation or modulation of network interactions. Only the enhancement of network interactions, but not the increase in local activation, leads to robust improvement of word learning. This emphasizes the need to develop new neuromodulation methods influencing network interactions. Our study suggests that this may be achieved through behavioral activation of one area and concomitant activation of another area with HD-tDCS.

Results from a first-in-human phase I safety trial to evaluate the use of a vascularized pericranial/temporoparietal fascial flap to line the resection cavity following resection of newly diagnosed glioblastoma.

PURPOSE: The efficacy of systemic therapies for glioblastoma (GBM) remains limited due to the constraints of systemic toxicity and blood-brain barrier (BBB) permeability. Temporoparietal fascial flaps (TPFFs) and vascularized peri cranial flaps (PCF) are not restricted by the blood-brain barrier (BBB), as they derive their vascular supply from branches of the external carotid artery. Transposition of a vascularized TPFF or PCF along a GBM resection cavity may bring autologous tissue not restricted by the BBB in close vicinity to the tumor bed microenvironment, permit ingrowth of vascular channels fed by the external circulation, and offer a mechanism of bypassing the BBB. In addition, circulating immune cells in the vascularized flap may have better access to tumor-associated antigens (TAA) within the tumor microenvironment. We conducted a first-in-human Phase I trial assessing the safety of lining the resection cavity with autologous TPFF/PCF of newly diagnosed patients with GBM. METHODS: 12 patients underwent safe, maximal surgical resection of newly diagnosed GBMs, followed by lining of the resection cavity with a pedicled, autologous TPFF or PCF. Safety was assessed by monitoring adverse events. Secondary analysis of efficacy was examined as the proportion of patients experiencing progression-free disease (PFS) as indicated by response assessment in neuro-oncology (RANO) criteria and overall survival (OS). The study was powered to determine whether a Phase II study was warranted based on these early results. For this analysis, subjects who were alive and had not progressed as of the date of the last follow-up were considered censored and all living patients who were alive as of the date of last follow-up were considered censored for overall survival. For simplicity, we assumed that a 70% PFS rate at 6 months would be considered an encouraging response and would make an argument for further investigation of the procedure. RESULTS: Median age of included patients was 57 years (range 46-69 years). All patients were Isocitrate dehydrogenase (IDH) wildtype. Average tumor volume was 56.6 cm3 (range 14-145 cm3). Resection was qualified as gross total resection (GTR) of all of the enhancing diseases in all patients. Grade III or above adverse events were encountered in 3 patients. No Grade IV or V serious adverse events occurred in the immediate post-operative period including seizure, infection, stroke, or tumor growing along the flap. Disease progression at the site of the original tumor was identified in only 4 (33%) patients (median 23 months, range 8-25 months), 3 of whom underwent re-operation. Histopathological analyses of those implanted flaps and tumor bed biopsy at repeat surgery demonstrated robust immune infiltrates within the transplanted flap. Importantly, no patient demonstrated evidence of tumor infiltration into the implanted flap. At the time of this manuscript preparation, only 4/12 (33%) of patients have died. Based on the statistical considerations above and including all 12 patients 10/12 (83.3%) had 6-month PFS. The median PFS was 9.10 months, and the OS was 17.6 months. 4/12 (33%) of patients have been alive for more than two years and our longest surviving patient currently is alive at 60 months. CONCLUSIONS: This pilot study suggests that insertion of pedicled autologous TPFF/PCF along a GBM resection cavity is safe and feasible. Based on the encouraging response rate in 6-month PFS and OS, larger phase II studies are warranted to assess and reproduce safety, feasibility, and efficacy. TRIAL REGISTRATION NUMBER AND DATE OF REGISTRATION FOR PROSPECTIVELY REGISTERED TRIALS: ClinicalTrials.gov ID NCT03630289, dated: 08/02/2018.

The involvement of rTPJ in intention attribution during social decision making: A TMS study.

The mini-Ultimatum Game (mini-UG) is a bargaining game used to assess the reactions of a responder to unfair offers made by a proposer under different intentionality conditions. Previous studies employing this task showed the activation of responders' right temporoparietal junction (rTPJ), which could be related to its involvement in judgments of intentionality. To verify this hypothesis, in the present study we applied online transcranial magnetic stimulation (TMS) over the rTPJ in responders during the mini-UG, in which we manipulated intention attribution implicitly. A cover story was employed to induce participants to believe they were interacting with another agent. We expected that interfering with the rTPJ could affect the ability of responders to assume proposers' perspective, producing higher rates of rejections of unfair offers when offers are perceived as independent from responders' intentionality to inequality. Twenty-six healthy women voluntarily participated in the study. In the mini-UG, an unfair distribution of the proposer (8/2 offer) was pitted against one of three alternative offers: fair-alternative (5/5), no-alternative (8/2), hyperfair-alternative (2/8). During the task, a train of TMS pulses was delivered at proposers' offer presentation in blocks of active (rTPJ) or control (Vertex) stimulation according to an ABAB design. As expected, findings showed that rejection of the no-alternative offers was higher under TMS stimulation of the rTPJ compared with the control TMS. This effect was modulated by the degree of trustworthiness in the cover story. These data contribute defining the mechanisms and brain areas underpinning social decision making as assessed by bargaining tasks.

Disengagement of attention with spatial neglect: A systematic review of behavioral and anatomical findings.

The present review examined the consequences of focal brain injury on spatial attention studied with cueing paradigms, with a particular focus on the disengagement deficit, which refers to the abnormal slowing of reactions following an ipsilesional cue. Our review supports the established notion that the disengagement deficit is a functional marker of spatial neglect and is particularly pronounced when elicited by peripheral cues. Recent research has revealed that this deficit critically depends on cues that have task-relevant characteristics or are associated with negative reinforcement. Attentional capture by task-relevant cues is contingent on damage to the right temporo-parietal junction (TPJ) and is modulated by functional connections between the TPJ and the right insular cortex. Furthermore, damage to the dorsal premotor or prefrontal cortex (dPMC/dPFC) reduces the effect of task-relevant cues. These findings support an interactive model of the disengagement deficit, involving the right TPJ, the insula, and the dPMC/dPFC. These interconnected regions play a crucial role in regulating and adapting spatial attention to changing intrinsic values of stimuli in the environment.

Human Prosocial Preferences Are Related to Slow-Wave Activity in Sleep.

Prosocial behavior is crucial for the smooth functioning of the society. Yet, individuals differ vastly in the propensity to behave prosocially. Here, we try to explain these individual differences under normal sleep conditions without any experimental modulation of sleep. Using a portable high-density EEG, we measured the sleep data in 54 healthy adults (28 females) during a normal night's sleep at the participants' homes. To capture prosocial preferences, participants played an incentivized public goods game in which they faced real monetary consequences. The whole-brain analyses showed that a higher relative slow-wave activity (SWA, an indicator of sleep depth) in a cluster of electrodes over the right temporoparietal junction (TPJ) was associated with increased prosocial preferences. Source localization and current source density analyses further support these findings. Recent sleep deprivation studies imply that sleeping enough makes us more prosocial; the present findings suggest that it is not only sleep duration, but particularly sufficient sleep depth in the TPJ that is positively related to prosociality. Because the TPJ plays a central role in social cognitive functions, we speculate that sleep depth in the TPJ, as reflected by relative SWA, might serve as a dispositional indicator of social cognition ability, which is reflected in prosocial preferences. These findings contribute to the emerging framework explaining the link between sleep and prosocial behavior by shedding light on the underlying mechanisms.

Dynamic functional connectivity in the right temporoparietal junction captures variations in male autistic trait expression.

Autistic individuals can experience difficulties with attention reorienting and Theory of Mind (ToM), which are closely associated with anterior and posterior subdivisions of the right temporoparietal junction. While the link between these processes remains unclear, it is likely subserved by a dynamic crosstalk between these two subdivisions. We, therefore, examined the dynamic functional connectivity (dFC) between the anterior and posterior temporoparietal junction, as a biological marker of attention and ToM, to test its contribution to the manifestation of autistic trait expression in Autism Spectrum Condition (ASC). Two studies were conducted, exploratory (14 ASC, 15 TD) and replication (29 ASC, 29 TD), using resting-state fMRI data and the Social Responsiveness Scale (SRS) from the Autism Brain Imaging Data Exchange repository. Dynamic Independent Component Analysis was performed in both datasets using the CONN toolbox. An additional sliding-window analysis was performed in the replication study to explore different connectivity states (from highly negatively to highly positively correlated). Dynamic FC was reduced in ASC compared to TD adults in both the exploratory and replication datasets and was associated with increased SRS scores (especially in ASC). Regression analyses revealed that decreased SRS autistic expression was predicted by engagement of highly negatively correlated states, while engagement of highly positively correlated states predicted increased expression. These findings provided consistent evidence that the difficulties observed in ASC are associated with altered patterns of dFC between brain regions subserving attention reorienting and ToM processes and may serve as a biomarker of autistic trait expression.

The neuroanatomy of visual extinction following right hemisphere brain damage: Insights from multivariate and Bayesian lesion analyses in acute stroke.

Multi-target attention, that is, the ability to attend and respond to multiple visual targets presented simultaneously on the horizontal meridian across both visual fields, is essential for everyday real-world behaviour. Given the close link between the neuropsychological deficit of extinction and attentional limits in healthy subjects, investigating the anatomy that underlies extinction is uniquely capable of providing important insights concerning the anatomy critical for normal multi-target attention. Previous studies into the brain areas critical for multi-target attention and its failure in extinction patients have, however, produced heterogeneous results. In the current study, we used multivariate and Bayesian lesion analysis approaches to investigate the anatomical substrate of visual extinction in a large sample of 108 acute right hemisphere stroke patients. The use of acute stroke patient data and multivariate/Bayesian lesion analysis approaches allowed us to address limitations associated with previous studies and so obtain a more complete picture of the functional network associated with visual extinction. Our results demonstrate that the right temporo-parietal junction (TPJ) is critically associated with visual extinction. The Bayesian lesion analysis additionally implicated the right intraparietal sulcus (IPS), in line with the results of studies in neurologically healthy participants that highlighted the IPS as the area critical for multi-target attention. Our findings resolve the seemingly conflicting previous findings, and emphasise the urgent need for further research to clarify the precise cognitive role of the right TPJ in multi-target attention and its failure in extinction patients.

Single Incision Dual Cover with Temporoparietal Fascial Flap for Exposed Cochlear Implant: A Novel Take on a Workhorse Flap.

Cochlear implant surgeries have become increasingly common in India, leading to a rise in complications such as cochlear implant exposure. To address this issue, we present a novel technique involving a single incision dual cover using the temporoparietal fascial flap (TPFF) and skin flap to give durable cover for exposed cochlear implants. Materials and Methods A retrospective study was conducted between December 2019 and December 2022 on patients who underwent the dual flap procedure for exposed cochlear implants. Results The average defect size was 2 × 2 cm, and the average length of hospital stay was 10 days. Fourteen skin flaps were closed primarily, while two required skin grafting for donor site closure. At the time of discharge, all wounds showed successful healing with intact skin coverage over the cochlear implant device site. The average follow-up period was 12 months, during which two patients had donor site scar alopecia, while others had adequate hair growth masking the scar. All patients consistently used their cochlear implants. Conclusion Our single-incision, dual cover TPFF + skin flap technique offers a reliable and innovative solution for managing exposed cochlear implants. With successful implant salvage and favorable postoperative outcomes, this approach demonstrates the versatility and reliability of the TPFF as an excellent option for reconstructive surgeons dealing with cochlear implant complications.

Parcellating the vertical associative fiber network of the temporoparietal area: Evidence from focused anatomic fiber dissections.

Introduction: The connectivity of the temporoparietal (TP) region has been the subject of multiple anatomical and functional studies. Its role in high cognitive functions has been primarily correlated with long association fiber connections. As a major sensory integration hub, coactivation of areas within the TP requires a stream of short association fibers running between its subregions. The latter have been the subject of a small number of recent in vivo and cadaveric studies. This has resulted in limited understanding of this network and, in certain occasions, terminology ambiguity. Research question: To systematically study the vertical parietal and temporoparietal short association fibers. Material and methods: Thirteen normal, adult cadaveric hemispheres, were treated with the Klinger's freeze-thaw process and their subcortical anatomy was studied using the microdissection technique. Results: Two separate fiber layers were identified. Superficially, directly beneath the cortical u-fibers, the Stratum proprium intraparietalis (SP) was seen connecting Superior Parietal lobule and Precuneal cortical areas to inferior cortical regions of the Parietal lobe, running deep to the Intraparietal sulcus. At the same dissection level, the IPL-TP fibers were identified as a bundle connecting the Inferior Parietal lobule with posterior Temporal cortical areas. At a deeper level, parallel to the Arcuate fasciculus fibers, the SPL-TP fibers were seen connecting the Superior Parietal lobule to posterior Temporal cortical areas. Discussion and conclusion: To our knowledge this is the first cadaveric dissection study to comprehensively study and describe of the vertical association fibers of the temporoparietal region while proposing a universal terminology.