The Role of Connectomics and Advanced Cortical Mapping in Awake Craniotomies for Eloquent Area Tumors: A Comprehensive Review

Purpose to explore the challenges and solutions in surgical management of brain tumors located in eloquent areas, with the goal of maximizing extent of resection (EOR) while preserving neurological function. New framework for neuro-oncology: The connectome-driven paradigm shift from localization to network understanding of the brain. Abstract: This comprehensive review evaluates advanced cortical mapping, resting-state functional MRI (rs-fMRI), and high-definition tractography integrated during awake craniotomies. We conducted a critical review of the literature, with an emphasis on cutting-edge studies examining how preoperative connectomic profiling used in combination with intraoperative direct electrical stimulation (DES) can inform maximal safe resection. By utilizing advanced mapping to identify and spare important subcortical white matter tracts, the risk of permanent postoperative deficits can be minimized. However, up to the present date current data provides evidence indicating substantial improvement in functional outcomes and overall survival after connectome-guided awake craniotomies with preservation of higher-order cognitive networks. Nevertheless, the task of routinely deploying these technologies requires standardized protocols and solid neuroinformatics software tools.