Intraoperative Brain Mapping in Multilingual Patients: What Do We Know and Where Are We Going?

Martín-Fernández, Jesús; Gabarrós, Andreu; Fernández-Coello, Alejandro

doi:10.3390/brainsci12050560

Cited by 3 publications

(1 citation statement)

References 124 publications

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“…Of note, DES was not applied, because her tumor was an extraaxial tumor, also probably because of the lack of surgical equipment in the middle of World War II, 42 and because DES was not regularly used at that time. 43 Currently, DES is the gold standard for identifying critical neural networks in vivo 29,44,45 not only for cortical mapping, but also at a subcortical level to preserve the connectivity, and then maintain the patient's QOL. 31,34,[46][47][48][49] Nonetheless, cognitive mapping has been neglected for decades by neurosurgeons who focused mostly on avoiding hemiplegia and aphasia, with no specific considerations concerning higher-order functions, 21,32,46,50 despite the fact that increasing the number of cognitive processes to be mapped, as well as the cognitive load during awake mapping, is associated with higher rates of return to work, reaching 94%-97% after LGG resection in some series.…”

Section: Discussionmentioning

confidence: 99%

Is intraoperative mapping of music performance mandatory to preserve skills in professional musicians? Awake surgery for lower-grade glioma conducted from a meta-networking perspective

Martín-Fernández,

Moritz-Gasser,

Herbet

et al. 2024

Neurosurgical Focus

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OBJECTIVE In surgery for lower-grade glioma (LGG) in professional musicians, for whom preserving music ability is essential, a critical question has emerged, namely, is it mandatory to include music performance during awake mapping, as proposed in several reports? In fact, music ability is subserved by a mosaic of interactive cognitive and emotional processes that rest on several networks. Therefore, from a meta-network perspective, the authors investigated whether an integrated multimodal monitoring of these cognitive and emotional functions during stimulation mapping could be efficient in maintaining musical skill. Indeed, it could be difficult for a patient to play a musical instrument in the surgical setting in addition to performing other tasks, such as movement and language. METHODS An awake mapping–guided resection for LGG without intraoperative music performance was performed in 3 professional musicians. Intraoperative tests were tailored to each patient depending on the critical corticosubcortical circuits surrounding the tumor, including not only sensorimotor or language skills but also higher-order functions with a constant multitasking during the resection. RESULTS Although music skills were not mapped during surgery, all patients resumed their professional activities, preserving the ability to play music and to perform concerts, to teach and to compose music, or to start learning a new instrument. CONCLUSIONS A connectome-based resection without intraoperative music performance seems effective in achieving maximal glioma removal while preserving crucial networks subserving musical skills, creativity, and music learning. Neurosurgery should evolve toward a meta-networking approach to better understand higher-order functions mediating complex behavior, such as being a professional musician.

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