Gliomas are neoplasms that arise from glial cell origin and represent the largest fraction of primary malignant brain tumours (77%). These highly infiltrative malignant cell clusters modify brain structure and function through expansion, invasion and intratumoral modification. Depending on the growth rate of the tumour, location and degree of expansion, functional reorganization may not lead to overt changes in behaviour despite significant cerebral adaptation. Studies in simulated lesion models and in patients with stroke reveal both local and distal functional disturbances, using measures of anatomical brain networks. Investigations over the last two decades have sought to use diffusion tensor imaging tractography data in the context of intracranial tumours to improve surgical planning, intraoperative functional localization, and post-operative interpretation of functional change. In this study, we used diffusion tensor imaging tractography to assess the impact of tumour location on the white matter structural network. To better understand how various lobe localized gliomas impact the topology underlying efficiency of information transfer between brain regions, we identified the major alterations in brain network connectivity patterns between the ipsilesional versus contralesional hemispheres in patients with gliomas localized to the frontal, parietal or temporal lobe. Results were indicative of altered network efficiency and the role of specific brain regions unique to different lobe localized gliomas. This work draws attention to connections and brain regions which have shared structural susceptibility in frontal, parietal and temporal lobe glioma cases. This study also provides a preliminary anatomical basis for understanding which affected white matter pathways may contribute to preoperative patient symptomology.
<b><i>Background:</i></b> Corpus callosotomy for medically intractable epilepsy is an effective ablative procedure traditionally achieved using either standard open craniotomy or with less-invasive approaches. Advances in robotic-assisted stereotactic guidance for neurosurgery can be applied for LITT for corpus callosotomy. <b><i>Clinical Presentations:</i></b> Two patients were included in this study. One was a 25-year-old female patient with extensive bi-hemispheric malformations of cortical development and medically refractory epilepsy, and the other was an 18-year-old male with medically refractory epilepsy and atonic seizures, who underwent a complete corpus callosotomy using robotic-assisted stereotactic guidance for LITT. <b><i>Results:</i></b> Both patients underwent successful intended corpus callosotomy with volumetric analysis demonstrating a length disconnection of 74% and a volume disconnection of 55% for patient 1 and a length disconnection of 83% and a volume disconnection of 33% for patient 2. Postoperatively, both patients had clinical reductions in seizure. <b><i>Conclusion:</i></b> Our experience demonstrates that robotic guidance systems can safely and effectively be adapted for minimally invasive LITT corpus callosotomy.
Histology requires visual literacy, the recognition and interpretation of tissue organization in the body, but this is a challenging skill for novice students to acquire. Developing pattern recognition requires expert guidance and exposure to diverse visual objects, which is limited by minimal contact hours in health sciences curricula. Using eye tracking, visual literacy is interpreted through visual scan paths. Novice students demonstrate improved visual scan paths and recognition of simple tissues after feed forward training (FFT) of an expert’s scan path, but this has yet to be tested in more complex tissues. The aim of the current IRB approved (#19‐1820) study is to apply FFT to complex histological tissues. Evidence suggests a high mental rotation test (MRT) score, ability to cognitively rotate and manipulate 2D objects, correlates with accelerated learning of visual objects. To account to MRT differences, this study evenly distributed participants into two groups, based on their MRT scores; while sex was evenly distributed. Both groups were a part of a two‐phase study. In phase one, group A received FFT on a series of 3 gastrointestinal (GI) organ micrographs showing: areas where the expert’s eyes fixated, pathway the eyes traveled across the micrograph (scan path), without focusing on distractors (saccades), and the total distance their eyes traveled across the image (total scan path distance). Group B viewed the same training micrographs, but FFT was omitted. Both groups were tested on visual identification of the 3 GI organs while their eye movements were captured by an eye‐tracking device, Gazepoint. Phase two was identical to phase one, except, students were exposed to the lymphatic system and group B received the FFT. 3,150 data points (N = 25) were collected and analyzed with MATLAB and SPSS. Neither group had a significant difference in scan path distance (A: p = 0.96; B: p = 0.83), or average fixation numbers (A: p = 0.25; B: p = 0.70) when analyzed individually. At phase two, both groups answered significantly faster (A: p < 0.01; B: p = 0.04) and their mean saccade length reduced (A: p = 0.01; B: p = 0.02). One‐way ANOVA on phase one data revealed female participants in both groups exhibiting less proficiency in visual search patterns with a significantly higher average fixation number (p < 0.01) and total scan path distance (p < 0.001) compared to their male counterparts. A linear regression revealed no correlation between the MRT and tissue identification accuracy (r = 0.35, p = 0.15), suggesting a high MRT may not be related to success in histology. Our data suggests watching an expert’s scan path improves visual literacy, and, for the first time, that there is a sex difference in histological search strategies. Future studies should examine if amount of time examining tissue specific areas of interest predict accuracy in testing.
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