Neurosurgery 00:1–9, 2025 (Published Online, October 15, 2025)
Resection of white matter tracts (WMTs) in language-critical glioma surgery robustly predicts permanent postoperative language deficits, particularly when parietal and temporal segments are involved. Frontal lobe WMTs are often safely resectable. Anatomical stratification enhances prediction, supporting data-driven, segment-specific surgical planning.
Resecting language-associated white matter tracts (WMTs) in glioma surgery robustly predicts permanent postoperative language deficits (PLDs).
• Frontal lobe WMT segments (e.g., arcuate fasciculus, IFOF, UF, SLF, FAT) are often resectable without causing PLDs.
• Resections in the temporoparietal junction (TPJ) and middle temporal lobe (MTL) significantly increase the risk of PLDs.
• Anatomically stratifying resections to parietal and temporal tracts improves prediction accuracy for PLDs (PPV increases to 50%).
• Volume of tract resected does not correlate with risk of PLDs; specific tract location is more important.
• Broca area and underlying white matter can often be resected safely, challenging traditional localizationist models.
• Combining imaging data with intraoperative mapping remains essential due to some nonfunctional tract segments leading to low PPV.
• Study limitations include small sample size, operator variability in tractography, and need for multicenter validation.
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