Abstract
Simple SummaryThis manuscript details the literature and discussion around revolutionizing the neurosurgeon’s approach to surgery for brain tumors by conceptualizing these tumors as entities within functional networks. We hope that the work detailed herein will aid in establishing neurosurgical paradigms to optimize planning for brain tumor surgery to improve functional outcomes for all patients.The evaluation and manipulation of structural and functional networks, which has been integral to advancing functional neurosurgery, is beginning to transcend classical subspecialty boundaries. Notably, its application in neuro-oncologic surgery has stimulated an exciting paradigm shift from the traditional localizationist approach, which is lacking in nuance and optimization. This manuscript reviews the existing literature and explores how structural and functional connectivity analyses have been leveraged to revolutionize and individualize pre-operative tumor evaluation and surgical planning. We describe how this novel approach may improve cognitive and neurologic preservation after surgery and attenuate tumor spread. Furthermore, we demonstrate how connectivity analysis combined with neuromodulation techniques can be employed to induce post-operative neuroplasticity and personalize neurorehabilitation. While the landscape of functional neuro-oncology is still evolving and requires further study to encourage more widespread adoption, this functional approach can transform the practice of neuro-oncologic surgery and improve the care and outcomes of patients with intra-axial tumors.
Highlights
The interaction between glial tumors and structural and functional neuronal networks is becoming increasingly recognized and is reshaping our understanding of the impact of these infiltrative lesions on global brain function
This paradigm shift of network analyses in functional neurosurgery can be applied to neuro-oncologic surgery to serve three important goals: (1) Mitigating tumor spread by considering the invasive nature of gliomas and their growth along white matter tracts, or so-called ‘oncologic disconnection’ [6,13]; (2) Preserving critical networks to maintain cognitive, social and occupational function post-operatively through recognition of the impact of resections on neural circuitry [6]; (3a) Harnessing neuroplasticity to induce functional reorganization through targeted neuromodulation, allowing for extended tumor resections [14]; and, (3b) Personalized strategies for post-operative neurorehabilitation through neuromodulation guided by connectivity maps
As has been demonstrated through the expanding applications within functional neurosurgery, personalized network-based approaches are anticipated to improve our overall understanding of brain function, as well as surgical, oncological, and functional outcomes for glioma patients
Summary
Nardin Samuel 1, Artur Vetkas 1,2,3, Aditya Pancholi 1, Can Sarica 1 , Aaron Loh 1, Jurgen Germann 1 , Irene E. We hope that the work detailed will aid in establishing neurosurgical paradigms to optimize planning for brain tumor surgery to improve functional outcomes for all patients
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