Enhancing Surgical Precision in Language Areas Through Personalized Structural and Functional Connectome- “A Glioma Language Connectome"

Objective: The language function in the human brain is crucial for communication, social interaction, cognition, decision making and problem solving.It is deeply embedded in neural networks, affecting nearly every aspect of our lives.During neurosurgical procedures, particularly those involving the language dominant hemisphere, preserving language function is a primary concern.This can be aided by Multimodal imaging which integrates different imaging techniques to provide a comprehensive brain structure, function, and connectivity.This preoperative mapping with connectome imaging allows seamless trajectory to prevent language deficits and when combined with Intraoperative direct cortical and subcortical mapping gives better results in resection of intra axial lesions around language areas.Methods: Structural and functional connectome scans were generated using voxelbox explore, a machine learning software to reparcellate a validated template of SENSAAS atlas(for language network) based on individual anatomical and functional connectivity mapped from resting state functional MRI and structural connectivity based on diffusion MRI.Structural connectivity imaging was assessed to identify at-risk parcellations, and seed-based analysis of the region of interest was performed to evaluate functional relationships.Major language tracts were mapped to maximize tumor removal while preserving baseline language.Results: Six patients with lesions involving left frontal or temporal lobe or both, around language dominant areas were included in the study.Imaging identified unique patterns of structural and functional connectivity, revealing distinct relationships within language networks.Multimodal connectome-guided preoperative planning, intraoperative navigation, and direct cortical-subcortical stimulation were utilized, with four patients maintaining intact language function and two patients demonstrating improved language function on follow-up compared to baseline.