Intraoperative awake language mapping correlates to preoperative connectomics imaging: An instructive case

• Published in: Clinical neurology and neurosurgery Vol. 229; p. 107751
• Main Authors: Shah, Harshal A., Ablyazova, Faina, Alrez, Annabelle, Wernicke, A. Gabriella, Vojnic, Morana, Silverstein, Justin W., Yaffe, Beril, D’Amico, Randy S.
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01.06.2023; Elsevier Limited
• Subjects: Brain cancer; Brain mapping; Brain Mapping - methods; Brain Neoplasms - diagnostic imaging; Brain Neoplasms - surgery; Brain tumor; Brain tumors; Connectome; Connectomics; Craniotomy - methods; Decision making; Humans; Language; Magnetic resonance imaging; Magnetic Resonance Imaging - methods; Mapping; Medical prognosis; Monitoring, Intraoperative - methods; Networks; Neuroimaging; Neurology; Neuropsychology; Neurosurgery; Planning; Speech; Speech mapping; Structure-function relationships; Surgery; Tumors; Wakefulness; Brain tumor; Speech mapping; Networks; Language; Connectomics
• ISSN: 0303-8467; 1872-6968; 1872-6968
• DOI: 10.1016/j.clineuro.2023.107751

Connectomics enables the study of structural-functional relationships in the brain, and machine learning technologies have enabled connectome maps to be developed for individual brain tumor patients. We report our experience using connectomics to plan and guide an awake craniotomy for a tumor impinging on the language area. Preoperative connectomics imaging demonstrated proximity of the tumor to parcellations of the language area. Intraoperative awake language mapping was performed, revealing speech arrest and paraphasic errors at areas of the tumor boundary correlating to functional regions that explained these findings. This instructive case highlights the potential benefits of implementing connectomics into neurosurgical planning. •Connectomics can be used to guide tumor resection.•Preoperative connectome scans can guide intraoperative awake language mapping.•Preserving functional aspects of the language network maintains language function postoperatively.