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Front. Behav. Neurosci. | doi: 10.3389/fnbeh.2018.00033

Neural networks mediating high-level mentalizing in patients with right cerebral hemispheric gliomas

Riho Nakajima1, Masashi Kinoshita1, Hirokazu Okita1, Tetsutaro Yahata1,  Mie MATSUI1 and  Mitsutoshi Nakada1*
  • 1Kanazawa University, Japan

Mentalizing is the ability to understand others’ mental state through external cues. It consists of two networks, namely low-level and high-level metalizing. Although it is an essential function in our daily social life, surgical resection of right cerebral hemisphere disturbs mentalizing processing with high possibility. In the past, little was known about the white matter related to high-level mentalizing, and the conservation of high-level mentalizing during surgery has not been a focus of attention. Therefore, the main purpose of this study was to examine the neural networks underlying high-level mentalizing and then, secondarily, investigate the usefulness of awake surgery in preserving the mentalizing network. A total of 20 patients with glioma localized in the right hemisphere who underwent awake surgery participated in this study. All patients were assigned to two groups: with or without intraoperative assessment of high-level mentalizing. Their high-level mentalizing abilities were assessed before surgery and 1 week and 3 months after surgery. At 3 months after surgery, only patients who received the intraoperative high-level mentalizing test showed the same score as normal healthy volunteers. The tract-based lesion symptom analysis was performed to confirm the severity of damage of associated fibers and high-level mentalizing accuracy. This analysis revealed the superior longitudinal fascicles (SLF) III and fronto-striatal tract (FST) to be associated with high-level mentalizing processing. Moreover, the voxel-based lesion symptom analysis demonstrated that resection of orbito-frontal cortex causes persistent mentalizing dysfunction. Our study indicates that damage of the orbito-frontal cortex and structural connectivity of the SLF and FST causes the disorder of mentalizing after surgery, and assessing high-level mentalizing during surgery may be useful to preserve these pathways.

Keywords: Mentalizing, fronto-striatal tract, Superior longitudinal fascicle, awake surgery, Glioma

Received: 08 Oct 2017; Accepted: 14 Feb 2018.

Edited by:

Nuno Sousa, Instituto de Pesquisa em Ciências da Vida e da Saúde (ICVS), Portugal

Reviewed by:

Emmanuel MANDONNET, Lariboisière Hospital, France
Goran Simic, School of Medicine, University of Zagreb, Croatia  

Copyright: © 2018 Nakajima, Kinoshita, Okita, Yahata, MATSUI and Nakada. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Prof. Mitsutoshi Nakada, Kanazawa University, Kanazawa, Japan,