Where are higher-order cognitive functions? The paradox of non-locality in awake cognitive mapping using a complex...

Area of Science:

• Neuroscience
• Cognitive Science
• Neurosurgery

Background:

• Higher-order cognitive functions, like social cognition and executive processes, are crucial but often underexplored in neurosurgery.
• These functions depend on dynamic, large-scale brain networks, not isolated regions, posing a challenge for localization.
• Preserving white-matter tracts is vital due to their limited neuroplasticity and the severe impact of lesions on cognition.

Purpose of the Study:

• To develop and demonstrate a three-step awake cognitive mapping approach for preserving higher-order cognitive functions during neurosurgery.
• To integrate computational neuroscience and network theory into clinical practice for improved patient outcomes.
• To minimize irreversible cognitive deficits by identifying and protecting critical network 'connectome-stop points'.

Main Methods:

• Direct electrical stimulation (DES) to identify critical network points through transient behavioral impairments.
• Continuous monitoring of multiple cognitive domains during tumor resection.
• Halting surgical resection at identified connectome-stop points to prevent functional loss.

Main Results:

• Demonstrated a novel methodology for awake cognitive mapping in a case of right parietal glioma.
• Successfully integrated computational neuroscience, network theory, and clinical practice.
• Achieved optimal functional preservation and maintained patient quality of life through targeted surgical intervention.

Conclusions:

• The proposed three-step awake cognitive mapping approach effectively preserves higher-order cognitive functions during neurosurgery.
• Identifying and protecting critical network points is essential for preventing irreversible cognitive deficits.
• This integrated methodology enhances patient quality of life by minimizing surgical impact on complex cognitive networks.