Related Experiment Video
Updated: Jan 12, 2026
Translational Brain Mapping at the University of Rochester Medical Center: Preserving the Mind Through Personalized Brain Mapping
Published on: August 12, 2019
Indirect cognitive mapping in glioma surgery in patients not eligible for awake craniotomy - how I do it
Patrick Vigren1,2, Hans Lindehammar3
1Department of Neurosurgery, Örebro University Hospital, Örebro, Sweden. patrick.vigren@regionorebrolan.se.
Abstract:
This paper illustrates a method to map cognitive subcortical white matter pathways in brain tumour surgery, in patients not eligible for awake intraoperative mapping. The latter being the gold standard, it is not feasible in all patients. Illustrated by three cases, the presented method includes a preoperative mapping of both motor and subcortical eloquent structures - such as arcuate fasciculus and basal ganglia - subsequentially using subcortical motor mapping as a landmark to indirectly identify the cognitive structures.
Insights
This study presents a novel method for mapping cognitive pathways during brain tumor surgery for patients unable to undergo awake mapping. It uses preoperative mapping and motor pathways as landmarks to identify critical cognitive white matter tracts.
Area of Science:
- Neurosurgery
- Neuroimaging
- Cognitive Neuroscience
Background:
- Awake intraoperative mapping is the gold standard for preserving cognitive function during brain tumor surgery.
- This technique is not feasible for all patients, particularly those with cognitive deficits or intolerance to prolonged procedures.
- There is a need for alternative methods to map critical cognitive pathways in these challenging cases.
Purpose of the Study:
- To illustrate a novel preoperative method for mapping cognitive subcortical white matter pathways in brain tumor surgery.
- To provide an alternative to awake mapping for patients ineligible for the gold standard procedure.
- To indirectly identify cognitive structures using established motor pathway landmarks.
Main Methods:
- Preoperative mapping of motor and subcortical eloquent structures (e.g., arcuate fasciculus, basal ganglia).
- Utilizing subcortical motor mapping as a landmark during surgery.
- Indirect identification of cognitive pathways based on proximity to mapped motor structures.
- Case study illustration of the method in three patients.
Main Results:
- The presented method successfully mapped cognitive subcortical white matter pathways in three neurosurgical cases.
- Preoperative planning and intraoperative landmarking allowed for indirect identification of critical cognitive tracts.
- The approach offers a viable alternative for patients unsuitable for awake mapping.
Conclusions:
- This method provides a valuable tool for neurosurgeons to navigate and preserve cognitive white matter pathways during brain tumor resection.
- It enhances surgical planning and safety for patients who cannot undergo awake intraoperative mapping.
- Further validation in larger cohorts is warranted to establish its widespread applicability.
