Mapping Connectivity Damage in the Case of Phineas Gage
a) The skull of Phineas Gage on display at the Warren Anatomical Museum at Harvard Medical School. b) CT image volumes were reconstructed, spatially aligned, and manual segmentation of the individual pieces of bone dislodged by the tamping iron (rod), top of the cranium, and mandible was performed. Surface meshes for each individual element of the skull were created. Based upon observations from previous examinations of the skull as well as upon the dimensions of the iron itself, fiducial constraint landmarks were digitally imposed and a set of possible rod trajectories were cast through the skull. This figure shows the set of possible rod trajectory centroids which satisfied each of the anatomical constraints. The trajectory nearest the mean trajectory was considered the true path of the rod and was used in all subsequent calculations. Additionally, voxels comprising the interior boundary and volume of the cranial vault were manually extracted and saved as a digital endocast of Mr. Gage's brain cavity. c) A rendering of the Gage skull with the best fit rod trajectory and example fiber pathways in the left hemisphere intersected by the rod. Graph theoretical metrics for assessing brain global network integration, segregation, and efficiency  were computed across each subject and averaged to measure the changes to topological, geometrical, and wiring cost properties. d) A view of the interior of the Gage skull showing the extent of fiber pathways intersected by the tamping iron in a sample subject (i.e. one having minimal spatial deformation to the Gage skull). The intersection and density of WM fibers between all possible pairs of GM parcellations was recorded, as was average fiber length and average fractional anisotropy (FA) integrated over each fiber.