Real-Time Neuropsychological Testing Protocol for Left Temporal Brain Tumor Surgery: A Technical Note and Case Report

Area of Science:

• Neurosurgery
• Cognitive Neuroscience
• Neuro-oncology

Background:

• Surgery in eloquent brain areas carries risks of neuropsychological deficits.
• Maximizing tumor resection improves survival, necessitating a balance between oncological and functional outcomes.
• Real-time neuropsychological testing (RTNT) is vital for monitoring cognitive status during awake surgery.

Purpose of the Study:

• To report on the application and utility of RTNT during awake surgery for a left temporal lobe glioma.
• To demonstrate how RTNT provides essential intraoperative feedback on patient's cognitive status.

Main Methods:

• A case report of a 25-year-old male with a temporo-insular low-grade glioma.
• Preoperative assessment included neuropsychological testing, fMRI, and DTI.
• Awake surgery with direct cortical stimulation and continuous RTNT was performed.

Main Results:

• Direct electrical stimulation identified a critical speech area.
• RTNT provided continuous feedback, with no significant performance drop observed.
• Minor decrements in specific cognitive tasks (e.g., verbal comprehension, memory) were noted and managed.

Conclusions:

• RTNT is an effective tool for providing real-time cognitive status information to surgeons during awake brain surgery.
• This intraoperative feedback aids in optimizing the onco-functional balance, ensuring maximal safe resection.
• RTNT contributes to preserving cognitive function and improving patient outcomes.