Individualized brain mapping for neurosurgical planning

The need for personalised approaches in neurosurgery arises from marked variations in the distribution and performance of functional networks among individual brains. Functional MRI and diffusion tractography have been widely adopted for neurosurgical planning. However, the way in which neuroimaging results are used clinically remains largely qualitative. This review explores how personalised neurosurgical mapping can move toward quantitative, patient-specific predictions by adopting techniques from the field of neuroscience. Exciting potential comes from extending our largely static measures of network organisation with metrics probing the dynamic nature of information processing in the brain. Such multidimensional approaches show promise to capture aspects of complex behaviour relevant to everyday function beyond the mainstream focus on language and motor skills. Yet, translation of advanced approaches into the clinic faces many challenges. Progress will require validated metrics capturing individually-unique patient profiles, methods for robust multimodal integration, clinically usable analytical tools, and outcomes that better capture real-life performance. By combining spatial, structural and temporal features of brain networks, neuroimaging may evolve from a 'localisation' tool into a platform for personalised neurosurgical prediction, intervention and longitudinal care.