Is intraoperative mapping of music performance mandatory to preserve skills in professional musicians? Awake surgery for lower-grade glioma conducted from a meta-networking perspective

Abstract

OBJECTIVE In surgery for lower-grade glioma (LGG) in professional musicians, for whom preserving music ability is essential, a critical question has emerged, namely, is it mandatory to include music performance during awake mapping, as proposed in several reports? In fact, music ability is subserved by a mosaic of interactive cognitive and emotional processes that rest on several networks. Therefore, from a meta-network perspective, the authors investigated whether an integrated multimodal monitoring of these cognitive and emotional functions during stimulation mapping could be efficient in maintaining musical skill. Indeed, it could be difficult for a patient to play a musical instrument in the surgical setting in addition to performing other tasks, such as movement and language. METHODS An awake mapping–guided resection for LGG without intraoperative music performance was performed in 3 professional musicians. Intraoperative tests were tailored to each patient depending on the critical corticosubcortical circuits surrounding the tumor, including not only sensorimotor or language skills but also higher-order functions with a constant multitasking during the resection. RESULTS Although music skills were not mapped during surgery, all patients resumed their professional activities, preserving the ability to play music and to perform concerts, to teach and to compose music, or to start learning a new instrument. CONCLUSIONS A connectome-based resection without intraoperative music performance seems effective in achieving maximal glioma removal while preserving crucial networks subserving musical skills, creativity, and music learning. Neurosurgery should evolve toward a meta-networking approach to better understand higher-order functions mediating complex behavior, such as being a professional musician.

Case report: when art is faced with brain surgery: acute change in creative style in a painter after glioma resection

“…By applying this concept to artists who should undergo removal for a brain glioma, it has recently been proposed to achieve awake surgery with intraoperative direct electrostimulation (DES) mapping while the patients are performing on-line multi-tasking throughout the resection into the operating room ( 13 ). This monitoring of several functional systems (e.g., sensorimotor, language, cognitive, emotional) in real-time, as a mirror of the meta-network, resulted in a tailored connectome-based resection which allowed professional musicians to resume their artistic activities following tumor resection: indeed, by preserving crucial networks subserving musical skills, learning and creativity, patients were able to not only to play music again but also to compose new pieces after brain surgery ( 14 ). One step forward, Shofty et al.…”