Resting-State vs. Task-Based Functional Magnetic Resonance Imaging in Neurosurgical Planning: A Narrative Review of...

Area of Science:

• Neurosurgery
• Neuroimaging
• Neurology

Background:

• Accurate presurgical localization of eloquent cortex and subcortical pathways is crucial in neurosurgery.
• This guides maximal safe resection while preserving neurological function.
• Brain tumors and epilepsy necessitate precise functional mapping.

Purpose of the Study:

• To compare the clinical utility of task-based functional magnetic resonance imaging (tb-fMRI) and resting-state functional magnetic resonance imaging (rs-fMRI) in neurosurgical populations.
• To evaluate their feasibility, validation, limitations, and workflow integration for presurgical functional mapping.

Main Methods:

• A non-systematic literature search was conducted across major databases (PubMed/MEDLINE, Scopus, Web of Science, Google Scholar) from inception to March 2026.
• The review focused on studies utilizing tb-fMRI and rs-fMRI for presurgical functional mapping in neurosurgical patients.

Main Results:

• Tb-fMRI is established for motor/language mapping but limited by patient cooperation and neurovascular coupling.
• Rs-fMRI provides a task-free alternative, valuable for non-cooperative, impaired, or pediatric patients, especially for sensorimotor mapping.
• Language mapping with rs-fMRI is less consistent; neither modality replaces intraoperative stimulation.

Conclusions:

• A multimodal presurgical strategy is recommended, prioritizing tb-fMRI in cooperative patients.
• Rs-fMRI should supplement tb-fMRI when task-based mapping is limited or infeasible.
• Integrating both with tractography, neuronavigation, and intraoperative mapping optimizes outcomes.