Connections, Tracts, Fractals, and the Rest: A Working Guide to Network and Connectivity Studies in Neurosurgery

Brain mapping and connectomics can probe networks that span the entire brain, producing a diverse range of outputs for probing specific clinically relevant questions. The potential for understanding the effect of focal lesions on brain function, cognition, and plasticity abounds, any one of which would likely yield more effective and safer neurosurgical strategies. However, the possibilities of advanced magnetic resonance imaging and connectomics have been somewhat underused in neurosurgery, arising from actual or perceived difficulties in either application or analysis. The present review builds on previous work describing the theoretical attractions of connectomics to deliberate on the practical details of performing high-quality connectomics studies in neurosurgery. First, the data and methods involved in deriving connectomics models will be considered, specifically for the purpose of determining the nature of inferences that can be made subsequently. Next, a selection of key analysis methods will be explored using practical examples that illustrate their effective implementation and the insights that can be gleaned. The principles of study design will be introduced, including analysis tips and methods for making efficient use of available resources. Finally, a review of the best research practices for neuroimaging studies will be discussed, including principles of open access data sharing, study preregistration, and methods for improving replicability. Ultimately, we hope readers will be better placed to appraise the current connectomics studies in neurosurgery and empowered to develop their own high-quality studies, both of which are key steps in realizing the true potential of connectomics and advanced neuroimaging analyses in general.