Human self and Neurosurgery: Advances and insights from Geneva

Area of Science:

• Neurosurgery and Neuroscience
• Cognitive Neuroscience
• Neurophysiology

Background:

• The preservation of the human self is an emerging concern in neurosurgical practice.
• Understanding neural correlates of self-consciousness is key for protecting patient identity during brain tumor surgery.
• The concept of
• onco-functional balance
• needs to evolve to include self-identity.

Purpose of the Study:

• To synthesize evidence for integrating the concept of self into neurosurgical practice.
• To build a framework for identifying, monitoring, and protecting neural correlates of self-consciousness during brain tumor surgery.
• To propose a reconceptualization of
• eloquent
• cortex to include self-related structures.

Main Methods:

• Review of neuroimaging, neuropsychology, and intraoperative neurophysiology literature.
• Description of anatomical and functional bases of self-awareness, including interoception, multisensory integration, and cortical networks (medial prefrontal cortex, insula, temporoparietal junction).
• Outline of perioperative assessment tools: anosognosia scales, disownership scales, Self-Other Voice Discrimination (SOVD) paradigm, and Heartbeat-Evoked Potentials (HEPs).

Main Results:

• Bodily and cognitive self-awareness rely on specific brain regions and processes.
• Validated clinical scales and quantifiable markers like HEPs can assess self-processing.
• The medial prefrontal cortex, insula, and temporoparietal junction are critical for self-awareness.

Conclusions:

• Neurosurgery must explicitly aim to preserve the self alongside motor, sensory, and language functions.
• A shift towards an
• onco-functional-identity
• paradigm is proposed, making patient personality, agency, and awareness measurable endpoints.
• Future research should focus on real-time intraoperative monitoring of HEPs and developing functional risk maps for self-related brain structures.