Use of a Novel Intraoperative Neurocognitive Monitoring Task During Awake Craniotomy for Tumor Resection in the Language-Dominant Parietal Lobe

BACKGROUND AND OBJECTIVES: The identification of eloquent structures in the parietal lobe during awake craniotomy remains challenging, particularly for higher-order functions such as reading, calculation, and sensorimotor integration essential for writing and typing. Our study introduces a novel task as part of intraoperative neurocognitive monitoring (iNM) to enhance real-time assessment during tumor resection. METHODS: We introduced a novel tactile symbol recognition task during iNM to assess sensorimotor function of patients undergoing awake craniotomy at a single-center from January to February 2025. RESULTS: We present 2 cases of left parietal low-grade gliomas in right-handed males who underwent awake craniotomy with mapping and iNM. Intraoperatively, errors during tactile symbol recognition provided surgical guidance by indicating when to halt resection. Both patients achieved gross-total resection and demonstrated largely preserved postoperative function. CONCLUSION: Our findings suggest that real-time iNM can effectively complement traditional stimulation mapping, especially in complex regions such as the parietal lobe where critical functions are mediated by distributed neural networks. A tactile symbol recognition task is feasible and easy to implement as a patient-centered preservation approach in settings that may not have consistent access to other surgical mapping adjuncts and may offer a sensitive means of guiding intraoperative decisions and optimizing outcomes in eloquent cortex resections.