B – 100 Neuropsychological Tests and Considerations for Cognitive Monitoring of Social Cognition during Awake Craniotomy

Abstract Objective This review aims to identify and evaluate neuropsychological tasks and intraoperative mapping strategies used to monitor social cognition during awake craniotomy. The goal is to inform surgical practices that support cognitive preservation and patient quality of life. Method A qualitative review was conducted of 25 peer-reviewed studies that examined intraoperative monitoring of social cognition during awake craniotomy. Studies were identified through database searches in PubMed and PsycINFO using combinations of keywords such as “awake craniotomy,” “social cognition,” and “intraoperative mapping.” Inclusion criteria required that studies specifically addressed intraoperative tasks related to emotion recognition, mentalizing, or self-awareness. Results The Reading the Mind in the Eyes Test (RME) was the most frequently utilized tool for intraoperative social cognition monitoring, appearing in over 70% of studies that addressed this domain. In addition to RME, tasks assessing emotion recognition using full facial expressions, false belief understanding, and mental state prediction were commonly used. Emotion-specific disruption—such as altered recognition of anger and sadness—was associated with stimulation of the anterior insula. Intraoperative mapping consistently implicated right-hemisphere structures including the inferior fronto-occipital fasciculus (IFOF), arcuate fasciculus (AF), and superior longitudinal fasciculus (SLF) as essential for maintaining social cognitive function. Awake procedures using these assessments helped increase resection extent while reducing long-term deficits in emotion processing and interpersonal functioning. Conclusion Incorporating social cognition tasks into awake craniotomy allows for targeted mapping of higher-order cognitive functions beyond language and motor domains. These findings support the integration of social cognition monitoring into standard intraoperative protocols to optimize postoperative emotional and interpersonal functioning.