# Indirect cognitive mapping in glioma surgery in patients not eligible for awake craniotomy – how I do it

## TL;DR

This paper presents a surgical technique to map cognitive brain pathways in patients who cannot undergo awake brain surgery.

## Contribution

A novel indirect method for cognitive mapping in glioma surgery when awake craniotomy is not possible.

## Key findings

- Preoperative mapping of motor and subcortical structures helps identify cognitive pathways.
- Subcortical motor mapping serves as a landmark for cognitive structures.
- The method is demonstrated through three clinical cases.

## Abstract

This paper illustrates a method to map cognitive subcortical white matter pathways in brain tumour surgery, in patients not eligible for awake intraoperative mapping. The latter being the gold standard, it is not feasible in all patients. Illustrated by three cases, the presented method includes a preoperative mapping of both motor and subcortical eloquent structures – such as arcuate fasciculus and basal ganglia – subsequentially using subcortical motor mapping as a landmark to indirectly identify the cognitive structures.

The online version contains supplementary material available at 10.1007/s00701-025-06706-1.