Preserved metacognitive ability despite unilateral or bilateral anterior prefrontal resection

Brodmann area 10 (BA10) is thought to be at the summit of the prefrontal cortex's hierarchical organization. It is widely accepted that metacognitive abilities depend on the structural and functional properties of BA10. Our objective was to assess whether metacognition can be maintained after low-grade glioma surgery with BA10 resection. Three groups of participants were recruited: (i) patients having undergone resection of the right prefrontal cortex, including BA10 (n = 9); (ill patients having undergone resection of the right prefrontal cortex but not BA10 (n = 10); and (iii) healthy controls (n = 38). Importantly, we also included a patient (referred to as "PR") with resection of BA10 in the two hemispheres. The patients with resection of right BA10 had metacognitive performances that were indistinguishable from those of brain-damaged control patients and healthy controls. Crucially, PR's metacognitive ability was not only maintained but was even in the upper quartile of normal performances. Our findings demonstrate that the brain can redistribute and remap metacognition in response to injury. We thus provide experimental evidence against the conventional hypothesis whereby cognitive functions are directly and lastingly linked to particular cortical structures. The latter hypothesis seems to be particularly false for the highest levels of human cognition and for BA10.