501 Preserving Non-Canonical Pathways: Connectomics-Guided Preservation of the Frontal Aslant Tract in Brain Tumor Resection

INTRODUCTION: Connectomics-guided brain tumor resection has emerged as a novel tool in the neurosurgeon's armamentarium. Leveraging functional-structural imaging, this approach enables the identification of canonical and non-canonical networks vulnerable to tumor pathology and therapeutic interventions. Such insights facilitate customized surgical planning, optimizing the approach to lesions situated within or around eloquent areas to augment oncological and functional outcomes. METHODS: The approach involves integrating connectomic imaging into surgical planning in two patients with a left frontal glioma, and a cavernoma, situated adjacent to the left FAT. RESULTS: Pre-operative imaging revealed variable relationships of the FAT to the tumor (In cases of the left frontal glioma and cavernoma, FAT was shifted medially and laterally, respectively) requiring tailored surgical approaches for each case. Both patients underwent an awake-craniotomy with intra-operative neuromonitoring and connectomics-guidance. The variable relationship of the FAT was successfully accounted for using intraoperative navigation and mapping. No postoperative deficits were observed. CONCLUSIONS: The utilization of connectomics in supratentorial brain tumor surgery represents an innovative technique to enhance surgical precision and patient outcomes. By integrating connectomic imaging, neurosurgeons can navigate the intricate landscape around eloquent areas that are traditionally difficult to monitor, such as the FAT. These findings underscore the potential of connectomics to help optimize post-operative oncofunctional balance.