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Review
. 2025 Jan 7:14:1481430.
doi: 10.3389/fonc.2024.1481430. eCollection 2024.

Preoperative mapping techniques for brain tumor surgery: a systematic review

Augusto Leone  1   2 , Francesco Carbone  2   3 , Uwe Spetzger  2 , Peter Vajkoczy  1 , Giovanni Raffa  4 , Flavio Angileri  4 , Antonino Germanó  4 , Melina Engelhardt  1 , Thomas Picht  1   5 , Antonio Colamaria  3 , Tizian Rosenstock  1   6
Affiliations
Review

Preoperative mapping techniques for brain tumor surgery: a systematic review

Augusto Leone et al. Front Oncol. .

Abstract

Accurate preoperative mapping is crucial for maximizing tumor removal while minimizing damage to critical brain functions during brain tumor surgery. Navigated transcranial magnetic stimulation (nTMS), magnetoencephalography (MEG), and functional magnetic resonance imaging (fMRI) are established methods for assessing motor and language function. Following PRISMA guidelines, this systematic review analyzes the reliability, clinical utility, and accessibility of these techniques. A total of 128 studies (48 nTMS, 56 fMRI, 24 MEG) were identified from various databases. The analysis finds nTMS to be a safe, standardized method with high accuracy compared to direct cortical stimulation for preoperative motor mapping. Combining nTMS with tractography allows for preoperative assessment of short-term and long-term motor deficits, which may not be possible with fMRI. fMRI data interpretation requires careful consideration of co-activated, non-essential areas (potentially leading to false positives) and situations where neural activity and blood flow are uncoupled (potentially leading to false negatives). These limitations restrict fMRI's role in preoperative planning for both motor and language functions. While MEG offers high accuracy in motor mapping, its high cost and technical complexity contribute to the limited number of available studies. Studies comparing preoperative language mapping techniques with direct cortical stimulation show significant variability across all methods, highlighting the need for larger, multicenter studies for validation. Repetitive nTMS speech mapping offers valuable negative predictive value, allowing clinicians to evaluate whether a patient should undergo awake or asleep surgery. Language function monitoring heavily relies on the specific expertise and experience available at each center, making it challenging to establish general recommendations.

Keywords: brain mapping; brain tumor surgery; fMRI; language eloquent tumor; magnetoencephalography (MEG); motor eloquent tumors; navigated transcranial magnetic stimulation (nTMS); preoperative mapping.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Workflow of the systematic research concerning nTMS following PRISMA guidelines.
Figure 2
Figure 2
Workflow of the systematic research concerning fMRI following PRISMA guidelines.
Figure 3
Figure 3
Workflow of the systematic research concerning MEG following PRISMA guidelines.
Figure 4
Figure 4
nTMS characteristics (right-sided figure with kind permission from Nexstim).
Figure 5
Figure 5
fMRI characteristics.
Figure 6
Figure 6
MEG characteristics (right-sided figure approved by the National Institute of Mental Health, Department of Health and Human Services).
See this image and copyright information in PMC

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