A groundbreaking surgery performed on a patient known as “AB” has shed light on a new approach to preserving cognitive skills during complex brain tumor removal procedures. Last year, AB, a 45-year-old computer programmer, was diagnosed with a glioblastoma, a highly invasive brain tumor that required intricate surgery for removal. However, AB had one specific request for his surgical team – to protect his ability to play chess, a passion he had cultivated for 25 years.
The request was made to Dr. Andreu Gabarrós, head of neurosurgery at Bellvitge University Hospital in Spain. Known for his dedication to his patients, Dr. Gabarrós reached out to his colleagues in the field of neuroscience to develop a plan to map AB’s brain before and during the surgery. This mapping would help identify and preserve the brain regions crucial for AB’s chess skills.
Two researchers at the University of Barcelona, led by cognitive neuroscientist Antoni Rodríguez-Fornells, worked tirelessly to create a chess-preserving surgical protocol for AB’s procedure. Using functional magnetic resonance imaging (fMRI) to pinpoint the areas linked to AB’s chess performance, the team prepared for a unique surgical approach.
During the surgery, a procedure called electrical stimulation mapping (ESM) was conducted. This involved touching a live electrode to different spots on AB’s cerebral cortex while he was awake, to determine which areas were essential for his chess abilities. Through this process, the surgeons identified AB’s supramarginal gyrus (SMG) as a critical brain region for chess performance, a discovery not previously documented in brain-imaging studies of chess players.
One week post-surgery, AB experienced complications that affected his language and motor skills, delaying the assessment of his chess abilities. However, four months later, it was confirmed that his chess skills remained intact, albeit with slightly slower responses in complex tasks.
While the study was limited to one patient, it showcased a novel approach to preserving cognitive skills during brain tumor removal. The research, published in the journal Cortex, highlighted the importance of identifying and protecting functional brain structures involved in specific skills, such as chess playing.
The success of this surgery has paved the way for future endeavors in preserving cognitive abilities during brain surgeries. Dr. Rodríguez-Fornells and his team are currently working on a similar protocol to safeguard computer programming skills during tumor removal procedures. This innovative approach has garnered interest from experts in the field, who commend the team for their meticulous and forward-thinking methods.
As advancements in neurosurgery continue to evolve, the case of AB serves as a beacon of hope for patients facing complex brain tumor surgeries. By prioritizing the preservation of cognitive skills, surgeons can provide a better quality of life for their patients post-surgery, ensuring that they can continue to pursue their passions and lead fulfilling lives. Breaking down tasks into functions during surgery is crucial to understanding the effects of electrical stimulation, according to experts in the field. Dr. Emmanuel Mandonnet, a professor of neurosurgery at the University of Paris Cité in France, questions whether tying specific brain areas to tasks like chess play or computer programming is necessary for preparing patients for surgery. He believes that asking patients to perform standard cognitive tasks, such as repeating numbers backward, may be sufficient to identify critical areas that should be avoided during the operation.
While visual search abilities, like those examined in chess surgery protocols, may share neural processes with other tasks such as knitting, there are exceptions. For example, retrieving a rule about a specific chess move may require a more specialized approach. A recent study by researchers at the University Hospital of Montpellier in France found that having a musician patient play an instrument during surgery was not necessary to spare areas linked to musical skills. Instead, patients were asked to perform multiple tasks simultaneously, such as moving an upper limb while talking and switching between languages, to activate motor, auditory, and cognitive processes similar to playing an instrument.
The study mentioned in Cortex aimed to assess the impact of surgery on cognitive abilities, with the patient AB reporting that he was able to maintain his Elo rating post-surgery. This achievement highlights the success of the surgery and the importance of understanding the effects of electrical stimulation on different cognitive functions.
In conclusion, while some surgeries may involve tasks like chess play, the key is to tailor the approach to each patient’s specific needs. By breaking down tasks into functions and understanding the neural processes involved, surgeons can ensure that critical areas are preserved during surgery, ultimately leading to successful outcomes for patients.
