Despite mounting evidence pointing to the contrary, classical neurosurgery presumes many cerebral regions are non-eloquent, and therefore, their excision is possible and safe. This is the case of the precuneus and posterior cingulate, two interacting hubs engaged during various cognitive functions, including reflective self-awareness; visuospatial and sensorimotor processing; and processing social cues. This inseparable duo ensures the cortico-subcortical connectivity that underlies these processes. An adult presenting a right precuneal low-grade glioma invading the posterior cingulum underwent awake craniotomy with direct electrical stimulation (DES). A supramaximal resection was achieved after locating the superior longitudinal fasciculus II. During surgery, we found sites of positive stimulation for line bisection and mentalizing tests that enabled the identification of surgical corridors and boundaries for lesion resection. When post-processing the intraoperative recordings, we further identified areas that positively responded to DES during the trail-making and mentalizing tests. In addition, a clear worsening of the patient’s self-assessment ability was observed throughout the surgery. An awake cognitive neurosurgery approach allowed supramaximal resection by reaching the cortico-subcortical functional limits. The mapping of complex functions such as social cognition and self-awareness is key to preserving patients’ postoperative cognitive health by maximizing the ability to resect the lesion and surrounding areas.

尽管越来越多的证据表明事实并非如此，但经典神经外科认为许多大脑区域是非语言功能的，因此，它们的切除是可能且安全的。楔前叶和后扣带回就是这种情况，这两个相互作用的中枢在各种认知功能中发挥作用，包括反思性自我意识；视觉空间和感觉运动处理；和处理社交线索。这对密不可分的二人组确保了这些过程背后的皮质-皮质下连接。一名成人出现右侧楔前低级别胶质瘤侵犯后扣带回的情况，接受了直接电刺激（DES）的清醒开颅手术。定位上纵束 II 后，实现了超最大切除。在手术过程中，我们发现了线平分和心理化测试的正刺激部位，从而能够识别手术走廊和病灶切除的边界。在对术中记录进行后处理时，我们进一步确定了在路径制定和心理化测试期间对 DES 做出积极反应的区域。此外，在整个手术过程中，观察到患者的自我评估能力明显恶化。清醒的认知神经外科方法通过达到皮质-皮质下功能极限来实现超最大切除。社会认知和自我意识等复杂功能的映射是通过最大限度地切除病灶和周围区域的能力来保持患者术后认知健康的关键。