Cerebral correlates of visuospatial neglect: A direct cerebral stimulation study

Giuseppe Vallar, Lorenzo Bello, Emanuela Bricolo, Antonella Castellano, Alessandra Casarotti, Andrea Falini, Marco Riva, Enrica Fava, Costanza Papagno

Research output: Contribution to journalArticlepeer-review


Objective: To assess the role of the superior longitudinal fascicle, the inferior fronto-occipital fascicle, and the posterior parietal lobe in visuospatial attention in humans during awake brain surgery. Experimental design: Seven patients with hemispheric gliomas (six in the right hemisphere) entered the study. During surgery in asleep/awake anesthesia, guided by Diffusion Tensor Imaging Fiber Tractography, visuospatial neglect was assessed during direct electrical stimulation by computerized line bisection. Principal observations: A rightward deviation, indicating left visuospatial neglect, was induced in six of seven patients by stimulation of the parietofrontal connections, in a location consistent with the trajectory of the second branch of the superior longitudinal fascicle. Stimulation of the medial and dorsal white matter of the superior parietal lobule (corresponding to the first branch of the superior longitudinal fascicle), of the ventral and lateral white matter of the supramarginal gyrus (corresponding to the third branch of the superior longitudinal fascicle), and of the inferior occipitofrontal fasciculus, was largely ineffective. Stimulation of the superior parietal lobule (Brodmann's area 7) caused a marked rightward deviation in all of the six assessed patients, while stimulation of Brodmann's areas 5 and 19 was ineffective. Conclusions: The parietofrontal connections of the dorso-lateral fibers of the superior longitudinal fascicle (i.e., the second branch of the fascicle), and the posterior superior parietal lobe (Brodmann's area 7) are involved in the orientation of spatial attention. Spatial neglect should be assessed systematically during awake brain surgery, particularly when the right parietal lobe may be involved by the neurosurgical procedure.

Original languageEnglish
Pages (from-to)1334-1350
Number of pages17
JournalHuman Brain Mapping
Issue number4
Publication statusPublished - 2014


  • Cerebral cortex
  • Diffusion tensor imaging
  • Electrical stimulation of the brain
  • Glioma
  • Hemispatial neglect
  • Neuropsychology
  • Neurosurgery
  • Right cerebral hemisphere

ASJC Scopus subject areas

  • Clinical Neurology
  • Anatomy
  • Neurology
  • Radiology Nuclear Medicine and imaging
  • Radiological and Ultrasound Technology
  • Medicine(all)


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