Abstract

Purpose: The integration of brain connectomics into neurosurgical practice represents a paradigm shift in glioma management, transitioning from lesion-centered strategies toward a network-based framework emphasizing preservation of structural and functional connectivity. Advances in diffusion and functional imaging, tractography, and computational modeling enable visualization and preservation of key white matter pathways and functional hubs, supporting safer, more effective resections. This review synthesizes current evidence on connectomics in glioma surgery, emphasizing region-specific surgical approaches and their relationships to cognitive and motor networks. Methods: We performed a structured narrative review of the literature on connectomics in glioma surgery, focusing on clinically relevant applications. Key domains included awake brain mapping, region-specific approaches, advancements in tractography— including edema- and free water–corrected techniques—intraoperative mapping strategies, postoperative recovery, and emerging artificial intelligence (AI)–driven tools. Representative studies were synthesized to highlight translational and surgical implications. Results: Connectomics has been associated with improved extent of resection and reduced postoperative deficits in clinical series. These benefits are driven by improved delineation of eloquent white matter tracts, including the corticospinal tract, superior longitudinal fasciculus, and inferior fronto-occipital fasciculus. Advanced tractography enhances visualization of peritumoral networks and reduces false-negative pathway identification. Intraoperative modalities, particularly awake mapping and direct electrical stimulation, remain essential for functional validation and boundary definition. Preservation of higherorder cognitive networks improves postoperative cognition and quality of life, while AI augments tract reconstruction and prediction of functional outcomes. Conclusion: Connectomics provides a clinically actionable framework for networkinformed glioma surgery, maximizing resection while minimizing morbidity.

Keywords

brain mapping, connectomics, glioma surgery, networks, neurosurgery