Here, we discuss challenges of electro-cortical mapping in localizing brain regions responsible for higher cognitive functions during awake brain surgery. The presenting case was that of a patient with recurrent anaplastic astrocytoma in the left inferior frontal gyrus, having no apparent symptoms of speech and cognition impairment preoperatively. Although his forward-and backward-digit span showed 6- and 5-digit numbers, respectively, preoperatively, he could not count backwards even for 3-digit numbers, intraoperatively. Cortical stimulation mapping during awake brain surgery caused errors during the forward counting task when the patient received electrical stimulation on the dorsolateral prefrontal cortex (DLPFC) , while for the Stroop color test, the patient showed positive responses when the same location was stimulated. No changes were observed during the object-naming task. The tumor was completely removed while preserving positively responding areas; no functional deficits were found postoperatively. The DLPFC plays an important role in working memory and attention. Although backward counting and n-back tasks could have directly estimated those functions, they were difficult to adapt to the specific conditions of awake brain surgery. Being less demanding performance tasks, forward counting and the Stroop color test were relatively more appropriate for use during awake brain surgery. Since the forward counting task is indicative of phonological rehearsal and the Stroop color test is associated with attention in cognitive control, those findings may reflect functions of attention in the DLPFC. Although only one case is presented here, further data collection may clarify localization of areas participating in cognitive functions.
Purpose: To evaluate needs of support in ensuring work readiness and facilitating reinstatement among patients with higher cognitive dysfunctions at the time of 1 year after injury, patients who returned to work, to school, and patients who were training for work readiness. Methods：This was a retrospective study of 100 patients（age, 17 to 59 years, 84 men and 16 women）with higher cognitive dysfunctions due to brain injury, who participated to cognitive rehabilitation in our hospi tal. Neuropsychological examinations, outcome, work readiness at the time of 1 year after injury was inves tigated. The effects of medical and social intervention in ensuring work readiness were analyzed, and out comes at 3 years were investigated. Results: After receiving medical rehabilitation in the hospital and social rehabilitation at the training center, 30％ of patients returned to work, and 5％ to school, at 1 year after injury. At the same time, 34％ of patients were training for work readiness in the hospitalʼs outpatientsʼ rehabilitation service and social reha bilitation training course for independent living and special career course in the vocational training center.Patients returned to work and to school showed significant higher score of Processing speed of WAIS-III, Profile of RBMT, Score of TMT A and B than patients who were training to return to work. Training patients needed more support for work readiness. However, at 3 years after injury, because of continuous training in work readiness, hospitalʼs outpatientsʼ rehabilitation service and social rehabilitation training course for independent living, in percentage of work ing individuals increased up to 51％. The training was achieved through collaboration between the hospital and training center. Conclusion: The results demonstrate that in patients with persistent substantial disability due to higher cognitive dysfunctions at 1 year after injury, interventions aimed to ensure work readiness are important and should involve both medical rehabilitation and social training. Such interventions facilitate return to work.