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Conducting Performance-Assisted Resections in the Right Temporo-Insular Cortex: A Real-Time Neuropsychological

Barbara Tomasino1, Ilaria Guarracino1, Tamara Ius2

  • 1Scientific Institute, IRCCS E. Medea, Dipartimento/Unità Operativa Pasian di Prato, 33037 Pasian di Prato, Italy.

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|September 27, 2025
PubMed
Summary

This study introduces real-time neuropsychological testing (RTNT) to monitor visuospatial and social cognition during right temporal lobe surgery. The protocol successfully assessed cognitive functions, aiding in preserving non-traditional surgical domains.

Keywords:
awake surgerygliomaneuropsychologytemporal lobe

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Area of Science:

  • Neurosurgery
  • Cognitive Neuroscience
  • Neuropsychology

Background:

  • Growing interest in preserving cognitive domains beyond traditional assessments during awake neurosurgery.
  • Focus on developing methods for surgical assistance in right temporal lobe resections.
  • Need for real-time cognitive monitoring during surgery, not just pre-operative assessment.

Purpose of the Study:

  • To propose and evaluate a real-time neuropsychological testing (RTNT) protocol for surgical resection in the right temporal areas.
  • To assess visuospatial and social cognition domains during the resection itself.
  • To maintain pre-surgery cognitive performance levels throughout the surgical procedure.

Main Methods:

  • Implementation of RTNT protocol in 24 patients undergoing right temporal lobe surgery.
  • Repeated administration of tasks evaluating visuospatial and social cognition during the resection.
  • Utilized varied task items to maintain accuracy and assess cognitive function in real-time.

Main Results:

  • Statistically significant differences observed in patient performance across tasks and RTNT runs.
  • Identified specific tasks (landmark, face recognition, theory of mind) sensitive to cognitive changes during surgery.
  • No significant difference in the number of patients scoring below normal range pre- vs. post-intervention.

Conclusions:

  • Demonstrated the feasibility of continuous cognitive monitoring during surgical resection.
  • Highlighted the potential of selected neuropsychological tasks for assessing right hemisphere visuospatial and social functions.
  • RTNT protocol can aid surgeons in preserving critical cognitive domains during temporal lobe surgery.