Department of Neurosurgery, Geneva University Medical Center & Faculty of Medicine, University of Geneva, Rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland.
Functional Brain Mapping Laboratory, Department of Fundamental Neurosciences, University Geneva, Geneva, Switzerland.
Acta Neurochir (Wien). 2021 May;163(5):1213-1226. doi: 10.1007/s00701-021-04778-3. Epub 2021 Mar 8.
Surgical treatment of tumors, epileptic foci or of vascular origin, requires a detailed individual pre-surgical workup and intra-operative surveillance of brain functions to minimize the risk of post-surgical neurological deficits and decline of quality of life. Most attention is attributed to language, motor functions, and perception. However, higher cognitive functions such as social cognition, personality, and the sense of self may be affected by brain surgery. To date, the precise localization and the network patterns of brain regions involved in such functions are not yet fully understood, making the assessment of risks of related post-surgical deficits difficult. It is in the interest of neurosurgeons to understand with which neural systems related to selfhood and personality they are interfering during surgery. Recent neuroscience research using virtual reality and clinical observations suggest that the insular cortex, medial prefrontal cortex, and temporo-parietal junction are important components of a neural system dedicated to self-consciousness based on multisensory bodily processing, including exteroceptive and interoceptive cues (bodily self-consciousness (BSC)). Here, we argue that combined extra- and intra-operative approaches using targeted cognitive testing, functional imaging and EEG, virtual reality, combined with multisensory stimulations, may contribute to the assessment of the BSC and related cognitive aspects. Although the usefulness of particular biomarkers, such as cardiac and respiratory signals linked to virtual reality, and of heartbeat evoked potentials as a surrogate marker for intactness of multisensory integration for intra-operative monitoring has to be proved, systemic and automatized testing of BSC in neurosurgical patients will improve future surgical outcome.
手术治疗肿瘤、癫痫灶或血管源性疾病需要详细的个体化术前评估和术中脑功能监测，以最大程度降低术后神经功能缺损和生活质量下降的风险。大多数注意力都集中在语言、运动功能和感知上。然而，社交认知、个性和自我意识等高级认知功能可能会受到脑手术的影响。迄今为止，这些功能所涉及的脑区的精确定位和网络模式尚未完全理解，使得评估相关术后缺陷的风险变得困难。神经外科医生有兴趣了解他们在手术过程中干扰了哪些与自我和个性相关的神经系统。最近使用虚拟现实和临床观察的神经科学研究表明，脑岛、内侧前额叶皮质和颞顶联合区是一个专门用于基于多感觉躯体处理的自我意识的神经网络的重要组成部分，包括外感受和内感受线索（躯体自我意识（BSC））。在这里，我们认为使用靶向认知测试、功能成像和 EEG、虚拟现实以及多感觉刺激相结合的额外和术中联合方法可能有助于评估 BSC 和相关认知方面。尽管需要证明特定生物标志物（如与虚拟现实相关的心脏和呼吸信号）和心跳诱发电位作为多感觉整合完整性的术中监测替代标志物的有用性，但对神经外科患者的 BSC 进行系统性和自动化测试将改善未来的手术结果。
