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<p>Connectome-guided glioma surgery integrates diffusion tractography and functional network mapping to optimize maximal safe resection while minimizing cognitive morbidity.To synthesize outcome-based evidence evaluating the impact of connectome- and tractography-guided glioma resections on postoperative neurocognition, white matter tract preservation, and oncologic extent of resection (EOR).&#xa0;Following PRISMA-2020 guidelines, we systematically reviewed studies (2017–2025) reporting clinical outcomes after connectome- or tractography-guided glioma surgery. Data included study design, technique, number of patients, and effect sizes. Random-effects meta-analyses (DerSimonian–Laird) pooled odds ratios (OR) and 95% confidence intervals (CIs).&#xa0;Twenty-four studies (<i>n</i> ≈ 1,850) were included. Connectome-guided surgery is associated with fewer permanent postoperative neurocognitive deficits (pooled OR = 0.55, 95% CI 0.40–0.75; I² = 35%), improved white matter tract preservation (pooled OR = 1.25, 95% CI 1.10–1.42; I² = 40%), and maintained or improved EOR (pooled OR = 1.30, 95% CI 1.05–1.60; I² = 29%).&#xa0;Connectome-based surgical planning is associated with improved functional outcomes, while maintaining oncologic efficacy. These results support the adoption of individualized connectomic strategies as a standard in modern neuro-oncological practice.</p>

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Connectome-guided glioma resection: a systematic review of white matter tract preservation and postoperative neurocognition

  • 期刊论文

  • 发表日期：

    2026年2月4日

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  • Tomasz Tykocki,
  • Łukasz Rakasz

摘要

Connectome-guided glioma surgery integrates diffusion tractography and functional network mapping to optimize maximal safe resection while minimizing cognitive morbidity.To synthesize outcome-based evidence evaluating the impact of connectome- and tractography-guided glioma resections on postoperative neurocognition, white matter tract preservation, and oncologic extent of resection (EOR). Following PRISMA-2020 guidelines, we systematically reviewed studies (2017–2025) reporting clinical outcomes after connectome- or tractography-guided glioma surgery. Data included study design, technique, number of patients, and effect sizes. Random-effects meta-analyses (DerSimonian–Laird) pooled odds ratios (OR) and 95% confidence intervals (CIs). Twenty-four studies (n ≈ 1,850) were included. Connectome-guided surgery is associated with fewer permanent postoperative neurocognitive deficits (pooled OR = 0.55, 95% CI 0.40–0.75; I² = 35%), improved white matter tract preservation (pooled OR = 1.25, 95% CI 1.10–1.42; I² = 40%), and maintained or improved EOR (pooled OR = 1.30, 95% CI 1.05–1.60; I² = 29%). Connectome-based surgical planning is associated with improved functional outcomes, while maintaining oncologic efficacy. These results support the adoption of individualized connectomic strategies as a standard in modern neuro-oncological practice.