P14.51 Brain mapping for mentalizing in GBM patient

Abstract

BACKGROUND: Glioblastoma is a disease with very poor outcome. Most patients underwent maximal safe resection, especially focusing in the preservation of motor and language function. However, many caregivers were suffered from the blockage of emotion communication with patients. So the definition of maximal safe resection must include the preservation of cognition and mentalizing of patients. Here we present the experience of brain mapping in awake surgery to preserve mentalizing. MATERIAL AND METHODS: A 61-year-old male patient with headache was transferred to our hospital because of brain tumor on CT scan checked in another hospital. On the initial MRI, multi-septate cystic tumor was shown on left medial prefrontal area. The patient was recommended the surgical resection, but patient discharged with the denial of the operation. Ten days later, patient visited our hospital again with slowness of response by the enlargement of tumor size. The tumor extensively involved left cingulum and corpus callosum at anterior part. On diffusion tensor image, tumor located at mediosuperior part of inferior fronto-occipital fasciculus (IFOF). The patient showed deficit of visual and verbal memory, generative naming ability, and phonemic generative naming ability on preoperative neuropsychological test (SNSB-II). Pyramid and palm tree test (PPTT) and 'Reading the Mind in the Eyes' test (RMET) were also performed to evaluate the semantic association function and mentalizing preoperatively. RESULT(S): The patient underwent awake surgery with asleep-awake-asleep technique. The tumor was resected until identification of incorrect response to PPTT or RMET on subcortical stimulation (Ojeman stimulator, 1.5mA, 60Hz, biphasic). The histopathologic diagnosis was glioblastoma. Small part of tumor was remained on cingulum, but patient was discharged without change of mentalizing. CONCLUSION(S): Although the patients with glioblastomas show poor outcome, we think that it is important to consider the cognition and mentalizing of patients for emotion communication with caregivers. With awake surgery, mentalizing can be preserved in selective patients.