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Preoperative Functional MRI in Brain Tumor Surgery: Mapping Language and Motor Networks to Optimize Functional Preservation
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1
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| Subject:
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Clinical Applications of Brain Mappin
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Presenter Author:
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| Name:
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Farzaneh Kashi
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Author:
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| Name 1:
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Farzaneh Kashi - Corresponding - Presenter
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| Affiliation 1:
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Department of Medical Physics and Engineering, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
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| Name 2:
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Hadi Ahmadzadeh
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| Affiliation 2:
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Research Center for Molecular and Cellular Imaging (RCMCI), Tehran University of Medical Sciences, Tehran, Iran.
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| Name 3:
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Mehdi Ghasemi
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| Affiliation 3:
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Department of Medical Physics and Engineering, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
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| Name 4:
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Faezeh Kashi
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| Affiliation 4:
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Department of Radiation Sciences, Faculty of Paramedicine, Iran University of Medical Sciences, Tehran, Iran
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Abstract
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Original Research
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introduction :
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Preservation of language and motor networks is a central challenge in brain tumor surgery. Injury to these eloquent systems can result in lasting aphasia or paresis and substantially reduce quality of life. Preoperative functional MRI (fMRI) provides a non-invasive means of localizing language and motor networks and can guide resection planning toward maximal safe tumor removal. Both task-based and resting-state fMRI are used for this purpose, yet their accuracy is influenced by paradigm design, patient cooperation, tumor grade, and peritumoral hemodynamics. This narrative review examines the clinical utility, methodological considerations, and limitations of preoperative fMRI for mapping language and motor networks in adults with primary brain tumors.
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Methods:
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A narrative review of the English-language literature was conducted in PubMed/MEDLINE, Embase, Scopus, Web of Science, and Google Scholar from January 2015 through September 2026. Records were retrieved using the following keywords, alone and in combination: presurgical functional MRI, preoperative functional MRI, task-based fMRI, resting-state fMRI, language mapping, motor mapping, language network, motor network, brain tumor, glioma, eloquent cortex, direct electrical stimulation, and neurovascular uncoupling. To ensure thoroughness, backward and forward citation tracking of included articles was also performed. Studies were eligible for inclusion if they (i) enrolled adults with primary intra-axial brain tumors, (ii) reported preoperative task-based and/or resting-state fMRI specifically for language and/or motor network mapping, and (iii) provided extractable data on paradigm design, spatial localization of language or motor areas, concordance with intraoperative direct electrical stimulation (DES), and/or postoperative language or motor outcome. Pediatric series, non-tumoral indications, purely technical or phantom studies, and reports without extractable language or motor mapping data were excluded. Thirty-five articles met the inclusion criteria. Data extraction focused on the accuracy of language and motor network localization, concordance with DES, and factors that degrade BOLD reliability, particularly neurovascular uncoupling (NVU) in high-grade gliomas.
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Results:
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Across the 35 included studies, task-based fMRI localized core motor cortex and perisylvian language regions with clinically useful spatial correspondence to DES, more consistently for motor than for language mapping. False-positive activations were mainly related to co-activation of non-essential cortex. In contrast, neurovascular uncoupling in the peritumoral zone, especially in high-grade gliomas, more often suppressed BOLD responses and produced false-negative maps of language and motor networks. Resting-state fMRI provided complementary localization of these networks in patients unable to perform task paradigms, but remained vulnerable to NVU. The contribution of preoperative fMRI to preservation of language and motor function depended on tumor grade, proximity to eloquent cortex, paradigm quality, and patient compliance.
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Conclusion:
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Preoperative fMRI is a clinically valuable adjunct for mapping language and motor networks before brain tumor resection. Its accuracy is modulated by tumor biology and peritumoral hemodynamics; recognition of NVU is essential for correct interpretation. Multimodal planning that combines fMRI with DES and diffusion tractography is recommended to optimize the balance between extent of resection and preservation of language and motor function.
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| Attachment:
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| Keywords:
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Preoperative functional MRI, presurgical functional MRI, task-based fMRI, resting-state fMRI, language mapping, motor mapping, glioma, neurovascular uncoupling, direct electrical stimulation
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