Unlocking the mind: brain mapping for the exploratory quest of functional and cognitive networks in awake neurosurgery

This retrospective study investigated the efficacy of intraoperative brain stimulation in 18 awake patients undergoing resection of intracranial lesions. The goal was to maximize resection while preserving cognitive function. We analyzed 91 stimulation sites using direct electrical stimulation (DES) during motor, language, and mentalizing tasks, with spatial response patterns identified via DBSCAN clustering. While all patients recovered their cognitive abilities, motor arrest was the most frequent response, highlighting the necessity of mapping motor pathways for preserving overall quality of life. Language responses confirmed classic functional hubs and the unpredictability of individual localization. Mentalizing, assessed via the “Reading the Mind in the Eyes” (RME) test, was minimally affected (1/91 sites). Clustered brain maps further support the necessity of DES to refine clinical nodes definitions, emphasizing the interplay of neural networks and subcortical connectivity in neuroplasticity. These exploratory findings suggest that comprehensive motor and language mapping during awake neurosurgery may support the stability of higher cognitive networks, though further research with larger cohorts and longitudinal neuropsychological tests is required to confirm these indirect preservation effects.