Al Awadhi Abdullah, Kiss-Bodolay Daniel, Grannò Simone, Ronchi Roberta, Bobbink-Blondiaux Eva, Tyrand Rémi, Boëx Colette, Voruz Philippe, Iannotti Giannina Rita, Péron Julie, Herbelin Bruno, Blanke Olaf, Schaller Karl
Division of Neurosurgery, Department of Clinical Neuroscience, University Hospitals of Geneva (HUG), Switzerland.
General and Cognitive Neurology Unit, Division of Neurology, Department of Clinical Neuroscience, University Hospitals of Geneva (HUG), Switzerland.
Brain Spine. 2025 Aug 6;5:104385. doi: 10.1016/j.bas.2025.104385. eCollection 2025.
The preservation of the human self-a fundamental yet underexplored aspect of neurosurgical practice-has gained increasing attention in recent years.
How can neural correlates of self-consciousness be identified, monitored, and protected during brain tumor surgery, and how might this reshape the concept of "onco-functional balance"?
This review synthesizes emerging evidence from neuroimaging, neuropsychology, and intraoperative neurophysiology to build a framework for integrating the concept of self into modern neurosurgical practice.
We describe the anatomical and functional basis of bodily and cognitive self-awareness, highlighting the roles of interoception, multisensory integration, and higher-order cortical networks such as the medial prefrontal cortex, insula and temporoparietal junction. We outline perioperative tools for clinical assessment, including validated scales for anosognosia and disownership, as well as the Self-Other Voice Discrimination (SOVD) paradigm and Heartbeat-Evoked Potentials (HEPs), which offer quantifiable markers of self-processing.
We argue for a reconceptualization of "eloquent" cortex to include regions critical for the preservation of self. As neurosurgery advances toward precision-guided, patient-centered care, protecting the self must become an explicit goal alongside motor, sensory, and language preservation. Future directions include real-time intraoperative monitoring of HEPs, development of functional risk maps for self-related structures, and broader implementation of personalized, neurocognitive surgical planning.Ultimately, this work proposes a shift from an "onco-functional" to an "onco-functional-identity" paradigm-where the integrity of the patient's personality, agency, and awareness becomes a measurable, preservable endpoint of neurosurgical care.
人类自我的保护——神经外科实践中一个基本但未被充分探索的方面——近年来受到了越来越多的关注。
在脑肿瘤手术期间，如何识别、监测和保护自我意识的神经关联，以及这可能如何重塑“肿瘤功能平衡”的概念？
本综述综合了神经影像学、神经心理学和术中神经生理学的新证据，以构建一个将自我概念整合到现代神经外科实践中的框架。
我们描述了身体和认知自我意识的解剖学和功能基础，强调了内感受、多感官整合以及内侧前额叶皮质、岛叶和颞顶交界等高级皮质网络的作用。我们概述了用于临床评估的围手术期工具，包括用于疾病感缺失和自我失认的有效量表，以及自我-他人语音辨别（SOVD）范式和心跳诱发电位（HEPs），它们提供了自我处理的可量化指标。
我们主张对“明确功能”皮质进行重新概念化，以纳入对自我保护至关重要的区域。随着神经外科向精准引导、以患者为中心的护理发展，保护自我必须成为与运动、感觉和语言保护并列的明确目标。未来的方向包括对HEPs进行术中实时监测、开发与自我相关结构的功能风险图谱，以及更广泛地实施个性化的神经认知手术规划。最终，这项工作提出了从“肿瘤功能”范式向“肿瘤功能-身份”范式的转变——患者的个性、能动性和意识的完整性成为神经外科护理中一个可测量、可保留的终点。
