神经可塑性是一种在面对损伤时，保持神经回路功能的能力。这也是使得脑肿瘤臭名昭著的原因之一。因此，我们评估了原发性脑肿瘤患者的特征，比较了接受左侧或右侧肿瘤觉醒开颅手术的患者之间的神经心理缺陷，并分析了右侧肿瘤患者的白质束与神经心理缺陷的关联。本研究利用长庚记忆医院2014年至2020年的登记数据集，共纳入了698例接受原发性脑肿瘤开颅手术的成年患者（其中538例接受常规开颅手术，160例接受觉醒开颅手术）。为觉醒开颅手术患者进行术前神经心理评估。觉醒开颅手术患者中，右侧肿瘤的比例较常规开颅手术患者低（33.8%和51.5%，p < 0.001）。觉醒开颅手术中，88.7%的左侧肿瘤患者和77.8%的右侧肿瘤患者存在神经心理障碍。左侧肿瘤患者在术前整体功能（36.2%和8.0%，p < 0.001）、语言领域（57.6%和22.2%，p < 0.001）和注意力（36.0%和18.5%，p = 0.02）方面表现出较差。此外，在右侧低级别胶质瘤患者中，涉及卓越纵束（SLF）I通路的患者在口头记忆（p = 0.001，奇比值=11.2，95% CI=1.8 ~ 71.4）和视觉记忆（p = 0.048，奇比值=10.5，95% CI=1.0 ~ 111）方面的缺陷风险较高。在觉醒开颅手术中，左侧大脑肿瘤患者在整体功能、语言和注意力方面的认知功能较右侧肿瘤患者较差。77%的右侧肿瘤患者存在神经心理障碍。因此，脑肿瘤患者需要进行全面的神经心理评估并接受觉醒开颅手术。 © 2023. 作者（作者）在Springer Science+Business Media, LLC的独家许可下，属于Springer Nature的一部分。

Neuroplasticity is an ability to maintain neural circuit function when facing damages. It is one of the reasons that making brain tumors notorious. Therefore, we evaluated the characteristics of patients with primary brain tumors, compared neuropsychological deficits between patients who had awake craniotomy with left- or right-sided tumors, and analyzed the association between white matter tracts and neuropsychological deficits in patients with right-sided tumors.Using the registration dataset of Chang Gung Memory Hospital between 2014 and 2020, this study included a total of 698 adult patients who received craniotomy for primary brain tumors (538 of conventional craniotomy; 160 of awake craniotomy). Neuropsychological assessments were arranged in patients as preoperative evaluation for awake craniotomies.A lower proportion of right-sided tumors was noted in patient who had awake craniotomy than those who had conventional craniotomy (33.8% and 51.5%, p < 0.001). In awake craniotomy, 88.7% of patients with left-sided tumors and 77.8% of patients with right-sided tumors had neuropsychological impairment. Patients with left-sided tumors had worse preoperative performance compared to those with right-sided tumors in global function (36.2% and 8.0%, p < 0.001), language domain (57.6% and 22.2%, p < 0.001), and attention (36.0% and 18.5%, p = 0.02). Furthermore, in those with right-sided low-grade gliomas, patients involving pathway of superior longitudinal fasciculus (SLF) I had a higher risk of deficits than those without involvement in verbal memory (p = 0.001, Odd ratio = 11.2, 95% CI = 1.8 ~ 71.4) and visual memory (p = 0.048, Odd ratio = 10.5, 95% CI = 1.0 ~ 111).In awake craniotomy, patients with left-sided brain tumors had worse cognitive function than those with right-sided tumors in terms of global function, language, and attention. 77% of patients with right-sided tumors had neuropsychological impairment. Therefore, a comprehensive neuropsychological evaluation and awake craniotomy are necessary for patients with brain tumors.© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.