# Convergent causal mapping unravels distinct frontal networks for visuospatial selective attention

## TL;DR

This study identifies brain regions involved in controlling visuospatial attention using data from brain tumor patients during surgery.

## Contribution

The study combines lesion mapping and direct stimulation to reveal causal frontal networks for attention.

## Key findings

- A right dorsomedial frontal region is linked to visuospatial neglect and attentional deployment.
- Stimulation of right ventrolateral white matter causes visuospatial errors in both hemifields.
- A tool was developed to preserve frontal connectivity for attention during neurosurgery.

## Abstract

Orienting visuospatial attention towards relevant stimuli is vital for effective environmental interactions. Current attentional control models rely on functional neuroimaging, which is correlational, and lesion studies in stroke patients, affected by localization bias. Studying patients undergoing awake neurosurgery for brain tumour resection offers a unique chance to overcome these limitations and possibly enhance current neurofunctional models. We combined Lesion-Symptom-Mapping (LSM) in 163 brain tumour patients and Direct Electrical Stimulation (DES) in 47 patients during awake neurosurgery to unveil the network causally associated with visuospatial exploratory/selective attention. LSM and DES convergently identified a right dorsomedial frontal region linked to visuospatial neglect, potentially functioning as a pre-oculomotor hub for contralateral attentional deployment. Moreover, stimulation of right ventrolateral white matter was associated with visuospatial errors in both hemifields. Finally, we provided a tool that effectively detects and preserves frontal connectivity for visuospatial exploratory/selective attention in neurosurgical settings.

Lesion mapping and direct electrical stimulation in neurosurgical patients convergently identify a dorsomedial right frontal network supporting contralateral visuospatial selective attention. Differently, stimulation of ventrolateral pathways impairs attention bilaterally.