Emerging paradigms in connectome-guided neurosurgery for central nervous system tumors: a narrative review of structural and functional connectomics

Connectomics is a comprehensive mapping of structural and functional brain networks. It has introduced a paradigm shift in neurosurgery by redefining brain tumors as network disorders rather than isolated lesions. Unlike traditional surgeries, connectome-guided neurosurgery conceptualizes brain tumors as network disorders and aims to preserve brain function in resection. The objective was to study the role of connectome-guided neurosurgery in the management of Central Nervous System tumors and the use of structural and functional connectomics in tumor resection while preserving neurological function. Articles have been identified by searches of PubMed, Scopus and Google scholar from January 2000 to May 2025, using a combination of search terms like "connectomes," "neurosurgery," "central nervous system tumors," "brain mapping," "glioma surgery," "tractography," "neuroimaging," "functional MRI," "brain tumors," "functional connectomics," "structural connectomics," "connectome-guided neurosurgery," and "artificial intelligence" and addition of relevant references of articles. Included studies addressed both conventional and novel treatments for CNS tumors, including gliomas. Structural (DTI/tractography) and functional (fMRI, MEG, EEG) connectomes support preoperative planning, intraoperative guidance, and postoperative outcomes in CNS tumors. However, to reduce tumor size, a multiphase strategy is proposed by medical professionals, which includes rehabilitation, possible second surgery, and chemotherapy. Limitations of this study include tractography errors, fMRI neurovascular coupling, high costs, limited availability, and barriers to neurosurgeon training. Connectome-guided neurosurgery provides a paradigm shift from lesion-centric to network centric neurosurgery of CNS tumors. Although challenges remain, the use of connectomics with AI, intraoperative, and supramaximal resection strategies provides safe resection, reduces morbidity, and improves quality of life.