Conducting Performance-Assisted Resections in the Right Temporo-Insular Cortex: A Real-Time Neuropsychological Testing (RTNT) Protocol.

Background/objectives: There is increasing interest within cognitive neuro-surgery in preserving domains not traditionally assessed during awake surgery. The study aims at proposing a specific protocol to assist surgical resection in right temporal areas. Patients were not evaluated during direct cortical stimulation; instead, assessments occurred during the resection itself. The real-time neuropsychological testing (RTNT) protocol employed tasks evaluating visuospatial and social cognition, administered repeatedly throughout the resection using varied items.

Methods: A consecutive series of 24 patients (median age 44) performed RTNT. The aim of RTNT is to maintain high accuracy through resection. Lesions in the right temporal cortex and the subcortical white matter beneath can cause deficits; accordingly, not all of our patients had pre-surgery performance within the normal range. In this case, the aim of RTNT is to maintain the not perfect pre-surgery level.

Results: We found a statistically significant between-tasks difference in the patients' median values (across RTNT runs), in their minimum score reached during resection, and in the delta between performance at the last vs. the first RTNT run. The tasks that varied belonged to visual-spatial attention (landmark task), face processing (recognition of famous faces), and social cognition (theory of mind). The outcome was measured by pre- vs. post-surgery neuropsychological score comparison. The number of patients scoring below the normal range did not significantly differ between post- vs. pre-intervention.

Conclusions: Results demonstrated the feasibility of implementing a continuous monitoring protocol during the resection phase, and the potential of the selected tasks to assess visuospatial and social functions associated with the non-dominant (right) hemisphere.