尽管越来越多的证据表明相反,经典的神经外科假设许多大脑区域是非雄辩的,因此,他们的切除是可能的和安全的。前扣带和后扣带就是这种情况,在各种认知功能过程中参与的两个互动中心,包括反思性自我意识;视觉空间和感觉运动处理;以及处理社交线索。这种不可分割的二重奏确保了这些过程的皮质-皮质下连通性。一名表现出右前骨低度神经胶质瘤侵犯后扣带的成年人接受了直接电刺激(DES)的清醒开颅手术。在定位上纵束II后,实现了超最大切除。手术期间,我们发现了线平分和心理测试的阳性刺激部位,这些部位能够确定手术通道和边界以进行病灶切除.对术中记录进行后处理时,我们进一步确定了在试验制定和指导测试中对DES反应积极的区域.此外,在整个手术过程中观察到患者的自我评估能力明显恶化。清醒的认知神经外科方法通过达到皮质-皮质下功能极限而允许超最大切除。社会认知和自我意识等复杂功能的映射是通过最大化切除病变和周围区域的能力来保持患者术后认知健康的关键。
Despite mounting evidence pointing to the contrary, classical neurosurgery presumes many cerebral regions are non-eloquent, and therefore, their excision is possible and safe. This is the
case of the
precuneus and posterior cingulate, two interacting hubs engaged during various cognitive functions, including reflective self-awareness; visuospatial and sensorimotor processing; and processing social cues. This inseparable duo ensures the cortico-subcortical connectivity that underlies these processes. An adult presenting a right precuneal low-grade glioma invading the posterior cingulum underwent awake craniotomy with direct electrical stimulation (DES). A supramaximal resection was achieved after locating the superior longitudinal fasciculus II. During surgery, we found sites of positive stimulation for line bisection and mentalizing tests that enabled the identification of surgical corridors and boundaries for lesion resection. When post-processing the intraoperative recordings, we further identified areas that positively responded to DES during the trail-making and mentalizing tests. In addition, a clear worsening of the patient\'s self-assessment ability was observed throughout the surgery. An awake cognitive neurosurgery approach allowed supramaximal resection by reaching the cortico-subcortical functional limits. The mapping of complex functions such as social cognition and self-awareness is key to preserving patients\' postoperative cognitive health by maximizing the ability to resect the lesion and surrounding areas.