Acta Neurochirurgica (2025) 167:289
This article presents a neurosurgical technique for indirectly mapping cognitive subcortical white matter pathways during glioma resection in patients who cannot undergo awake craniotomy. Using preoperative DTI and fMRI to create a 3D functional map, the team employs intraoperative monopolar subcortical motor stimulation as a live landmark to infer and protect nearby cognitive tracts like the arcuate fasciculus and IFOF.
Three illustrative cases demonstrate planning limits based on measured motor stimulation thresholds (approx. 1 mA ≈ 1 mm) and show safe resections with preserved cognitive and motor function. The report discusses indications, limitations versus awake mapping, importance of patient counselling about transient deficits, and integration of neuronavigation, tractography, and intraoperative motor mapping.
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