The neuroanatomy of spatial awareness: a large-scale region-of-interest and voxel-based anatomical study

Lesion-symptom studies of spatial neglect and the attention deficits associated with this disorder draw a complex picture of the brain areas involved in spatial awareness. Several cortical regions and fiber tracts have been identified as predictors of behavioral performance, a pattern reflecting the large degree of methodological variance and modest sample sizes of many studies. Here, we examined the anatomical predictors of deficits of spatial exploration, reading and line bisection in 134 unselected stroke patients with post-acute, right-hemispheric brain injury. In order to neutralize shortcomings of traditional lesion-symptom analyses we used several methodological approaches: voxel-based lesion-symptom mapping focusing on binary groups or continuous performance measures, region-of-interest analyses and a 'minimal-lesion' method, comparing patients with highly selective deficits to specific brain areas. All four approaches converged on the central role of the right temporo-parietal junction and frontoparietal connections conveyed through the superior longitudinal fasciculus for contralateral deployment of attention and detection of task-relevant stimuli.