P01.19.A The temporo-parieto-occipital junction in the non-dominant hemisphere as a challenging hub for glioma surgery: functional and oncological outcomes

Abstract Background The temporo-parieto-occipital junction (TPOJ) in the non-dominant hemisphere is a complex region intersected by multiple white matter bundles (Optic radiations, Inferior-fronto-occipital tract, inferior-longitudinalis-tract, superior-longitudinalis-tract, vertical-occipital-tract, medial-dorsal-longitudinal-tract, parietal-aslant-tract), subserving several high-level neurological functions such as spatial recognition, visual agnosia, field, attention and working memory. Few data are available on optimum brain mapping strategy to be adopted for resecting tumors involving this area. Ideally it should allow surgeon effectively identify tracts safely preserve all functions. Material Methods We developed proper protocol approach area integrating, awake condition, intraoperative test (iVT) semantic association (SRAT) prevent agnosia memory, hand manipulation task (hMT) abilities. reviewed its efficacy series of 38 patients with TPOJ, looking functional (neurologic-neuropsychological) oncological (EOR) outcomes. we perform lesion symptom map disconnectome analysis evaluate what predict decline neuropsychological function which tract correlated performance. Results Feasibility was high were able complete protocol, lasted, average11 min cortically 25 subcortically. Specificity >95%. Immediate post-operative deficits documented 87.4% patients, permanent 3.9% (visual abilities). Attentive emotional domains those mostly affected evaluation. Lesion disconnectomic showed that postoperative decrease performance associated resection cluster voxels corresponding anterior portion temporo-parietal junction. mainly involved posterior segment middle longitudinal fasciculus (aMdLF pMdLF) parietal aslant (PAT). Conclusion Effective safe TPOJ feasible. adoption specific setting recommended achieve full preservation extend tumor resection. Further performed assess role subcortical tracts.