Is the right frontal cortex really crucial in the mentalizing network? A longitudinal study in patients with a slow-growing lesion

Assessing the subjective experience of others in terms of mental states, a brain function referred to as mentalizing, is achieved in the brain through a set of low-level perceptual and high-level inference-based processes. Because of its recurrent implication in fMRI studies, the right frontal cortex, especially in its inferolateral and dorsomesial parts, is posited to be a “core system” in the sustenance of these neurocognitive mechanisms. In this context, we reasoned that if the right frontal cortex is really crucial for mentalizing, its surgical resection, following diffuse low-grade glioma invasion, should induce irreversible impairments. To test this hypothesis, we designed a longitudinal experimental setup in which ten patients harboring a low-grade glioma in right frontal areas were assessed just before, immediately after and three months after a brain surgery. Two well-validated behavioral tasks, thought to evaluate both aspects of mentalizing, were administered. The results obtained provide evidence that widespread surgical excisions of the right prefrontal cortex do not induce a long-term worsening of both aspects of mentalizing, although some transitory effects are observed immediately after the surgery. They suggest also for the first time in the same sample of patients a possible double functional dissociation between low-level perceptual (posterior inferolateral prefrontal) and high-level inference-based (dorsomesial prefrontal) mentalizing processes. This overall finding challenges the traditional view according to which the right frontal cortex is an “essential cortical node” in the mentalizing network since it might be expected that massive surgical excisions of this brain area would have induced more definitive impairments.