Executive functional deficits during electrical stimulation of the right frontal aslant tract

• DOI: 10.1007/s11682-020-00439-8
• Publication Date: 2021-01-19T03:03:02Z
• Authors: Geert-Jan M. Rutten; Maud J. F. Landers; Wouter De Baene; Tessa Meijerink; Stephanie van der...; Jeroen H. B. Verheul
• Keywords: Brain Mapping; Brain Neoplasms; Brief Communication; Magnetic Resonance Imaging; Electric Stimulation; Frontal Lobe; 03 medical and health sciences; 0302 clinical medicine; Brain Neoplasms/diagnostic imaging; Humans; Wakefulness; Frontal Lobe/diagnostic imaging

AbstractDirect electrical stimulation mapping was used to map executive functions during awake surgery of a patient with a right frontal low-grade glioma. We specifically targeted the frontal aslant tract, as this pathway had been infiltrated by the tumor. The right frontal aslant tract has been implicated in executive functions in the neuroscientific literature, but is yet of unknown relevance for clinical practice. Guided by tractography, electrical stimulation of the frontal aslant tract disrupted working memory and inhibitory functions. In this report we illustrate the dilemmas that neurosurgeons face when balancing maximal tumor resection against optimal cognitive performance. In particular, we emphasize that intraoperative tasks that target cognitive functions should be carefully introduced in clinical practice to prevent clinically irrelevant responses and too early termination of the resection.