Pre- and intraoperative brain functional mapping in brain tumor surgery

Abstract

The surgical strategy for benign brain tumors should consider preserving brain functions. During pre- and intraoperative planning, the best surgical approach must be chosen based on tumor location and brain functions. It is now possible to visualize the localization of various brain functions using various imaging modalities, such as anatomical images for depicting the motor cortex or cranial nerves, diffusion tensor images for predicting white matter and functional MRI or a magnetoencephalogram. A three-dimensional fusion image that integrates functional and anatomical images is useful to understand functional localization before surgery and consider the surgical approach. Moreover, during surgery, it is important to validate the preoperative mapping of functional images with findings from intraoperative electrophysiological monitoring using a surgical navigation system. This article outlines the basic information, interpretation, and limitations in depicting the localization of brain function using anatomical images and depicting various functions of the white matter using diffusion tensor tractography and a surgical navigation system.