CONNECTOME-GUIDED AWAKE SURGERY FOR DIFFUSE GLIOMAS: NETWORK-LEVEL MAPPING OF LANGUAGE, EXECUTIVE FUNCTION, AND NEUROCOGNITIVE RESERVE

Аннотация

Background. In diffuse low- and high-grade gliomas involving eloquent and associative networks, neurosurgical decisions remain difficult because traditional localizationist mapping protects a limited set of cortical sites but may overlook distributed white-matter pathways and higher-order networks responsible for executive control, semantic integration, social cognition, and adaptive behavior.

Materials and methods. A structured narrative review is proposed using clinical trials, prospective cohorts, diagnostic-accuracy studies, systematic reviews, and relevant technical investigations. Evidence is organized by biological plausibility, technical performance, patient selection, safety, clinical effectiveness, reproducibility, and implementation. A prospective comparative study is specified for adults with unilateral supratentorial diffuse glioma adjacent to language, motor, salience, default-mode, or frontoparietal control networks, with conventional awake mapping focused primarily on motor and language tasks as the reference strategy.

Results. The synthesis addresses five domains: limitations of cortical localization, white-matter constraints on resection, higher-order cognitive mapping, neuroplasticity and staged surgery, functional outcomes beyond gross motor and language scales. The proposed primary endpoint is rate of return to preoperative work or study without persistent language, executive, or social-cognitive decline at six months; secondary endpoints include extent of resection, network disconnection score, postoperative aphasia, executive dysfunction, quality of life, seizure control, and longitudinal plasticity. Originality derives from linking technical accuracy to patient-centered outcomes, explicitly modeling uncertainty, and requiring external validation.

Conclusion. Standardized endpoints support reliable clinical comparison. Independent adjudication strengthens causal interpretation. Longitudinal follow-up clarifies therapeutic durability. Rigorous independent external validation remains essential.