Neurosurgery's Future: Connectomics Insights from CNS 2025

The 2025 CNS Annual Meeting delivered compelling evidence of a fundamental shift in how we approach neurosurgery. The research presented validates a transition away from traditional, generalized anatomical planning toward a personalized, network-based methodology. 

This evolution is driven by the accelerating role of connectomics—the detailed mapping of the brain's unique structural and functional connections. Connectomics is moving beyond theory, becoming the essential foundation for precise, outcome-driven surgical planning. 

The following key findings presented at the meeting demonstrate that a patient's individual connectome is quickly becoming the most crucial factor in defining surgical eloquence.

Improved Post-Operative Status: Preoperative connectomic analysis using Quicktome, visualizing both traditionally eloquent and higher cognitive networks, was associated with a significantly greater improvement in post-operative mRS scores at first follow-up for intra-axial tumor patients compared to those treated without connectomic analysis. This suggests that a surgical approach informed by a patient's unique connectome, not just traditional anatomy, leads to better functional preservation.

Kilgallon, J., O'Malley, G., Monahan, D., Pema, P., Sweeney, P., Metcalf, J., Shah, H., & Patel, N. Adoption Of Network Based Neurosurgery In The Resection Of Intra-Axial Tumors: A Single Surgeon Experience. 2025 CNS Annual Meeting.

Zero Deficits in Connectome-guided MIPS: Connectome-guided Minimally Invasive Parafascicular Surgery
(MIPS) for brain tumors, using tubular retractors and pre-operative connectomic analysis with Quicktome, was associated with a 0% rate of postoperative neurologic deficits compared to 43.8% in the traditional control group. The data suggests this approach optimizes functional preservation and promotes postoperative neuroplasticity, reinforcing the role of connectomics in surgical safety.

Mittelman, L., Sistiaga, I., Seenarine, N., Shah, H., Chen, J., Syed, S., Silverstein, J., Eichberg, D. G., Schulder, M., & D'Amico, R. S. Connectomic-Guided Minimally Invasive Tumor Resection Using Tubular Retractors: A Quantitative Tractometry Analysis with Al-Based Software. 2025 CNS Annual Meeting.

An Alternative to Awake Craniotomy: A pilot study comparing awake craniotomy with connectome-guided resection under general anesthesia for language-eloquent gliomas found the latter to be a viable alternative when awake craniotomy is contraindicated. While awake craniotomy remains the gold standard, language, motor, and KPS preservation was comparable between the two groups.

Vegiraju T, Marino A, Lunardi N, Mut M. Awake Craniotomy Versus Connectome-Guided Resection Under General Anesthesia for Language-Eloquent Gliomas: A Pilot Comparative Study. CNS 2025 Annual Meeting

Enhancing Global Network Integrity: Structural and functional connectomics allow for the quantitative assessment of changes in large-scale brain network connectivity post-resection. Improvements in tract-level symmetry and Fractional Anisotropy (FA) suggest the potential for not only preserving but also enhancing global network integrity. This further supports a personalized, connectome-informed definition of eloquence.

Sistiaga, I. L., Mittelman, L., Shah, H., Chen, J., Chen, J., Seenarine, N., Daniel G. Eichberg, M., Schulder, M., & D'Amico, R. S. Connectomics-based Quantitative Tractometry in Brain Tumor Surgery: Al-Guided Network Analysis for Optimizing Onco-Functional Balance. 2025 CNS Annual Meeting.

Pre- and Post-operative Functional Connectome: One study utilized Quicktome to analyze pre- and post-operative functional connectome changes in a vestibular schwannoma (VS) patient who experienced complete hearing loss. The analysis revealed that this post-operative hearing loss strongly correlated with the largest drop in the left language network's functional correlation and a significant increase in its network disruption.

Himic V, Ho A, Mayrand RC, et al. Functional connectome changes of hearing loss from vestibular schwannoma resection surgery. CNS 2025 Annual Meeting.

Prediction of Post-stroke Recovery: A pilot study evaluated how ischemic stroke-related disruption of brain networks predicts in-hospital prognosis of stroke patients using connectomic analysis. Seventeen patients with large vessel occlusion underwent rs-MRI within 48 hours, and eloquent and non-eloquent networks were reviewed via the Omniscient platform. Network involvement correlated with NIHSS sub-category components at 48 hours and discharge, revealing that disruption of SN, CEN, LAN, and Attention networks aligned with motor, language, and consciousness deficits. The extent of node & tract involvement reflected functional outcomes, indicating that Quicktome's connectome-based metrics may improve & represent an adjunct tool to early stroke prognostication, potentially guiding targeted rehabilitation beyond traditional imaging approaches.

Patel, D., Jaikumar, V., Sridhar, V., Leasher, E., Lim, J., Liu, C., Davies, J., Snyder, K., Levy, E., Siddiqui, A., Waqas, M. Mapping Recovery: Using Magnetic Resonance Tractography To Inform In-Hospital Prognosis In Stroke Patients. 2025 CNS Annual Meeting.

Prognostication and Therapy Allocation: Researchers from UMiami reported a novel approach using Quicktome to investigate functional network anomalies that directly correlate with post-operative neurological changes such as delirium, visual deficits, and language improvements. This has significant relevance in post-operative prognostication and allocation of therapy resources.

Himic V, Mayrand RC, Gersey ZC, et al. A novel approach to functional connectome quantification in brain tumor patients: a case series. 2025 CNS Annual Meeting

Exploring TMS for Deficits: A comprehensive review found that connectomics-guided Transcranial Magnetic Stimulation (TMS) using Quicktome shows superiority over standard anatomical targeting in several disorders, including major depression, stroke, and traumatic brain injury. Functional and structural imaging enables the identification of individualized stimulation targets, often correlating with improved symptom outcomes.

Mittelman, L., Duehr, J., Kazmi, J. S., Syed, S., Jerliu, G., Cater, E., & D'Amico, R. S. Precision Neuromodulation through Connectomics-Guided TMS: A Narrative Review of Clinical Applications and Future Directions. 2025 CNS Annual Meeting

Predicting Early Cognitive Decline after Resection: Researchers from UVA investigated how brain network disruption predicts glioma post-operative cognitive decline. In N=20 subjects, preoperative structural and functional connectome analyses identified that the invasion of key networks (DMN, CEN, SN) were linked to prediction of early cognitive decline following resection due to lower functional recovery scores. The findings show that connectomic insights can predict and reduce cognitive deficits after glioma surgery, improving outcomes and guiding safer, more personalized resections, while potentially identifying research allocation outcomes.

Asuzu, D., Kareddy, A., Mut Askun, M., Vegirajo, T. Cognitive Network Disruption Predicts Early Cognitive Decline After Glioma Resection. 2025 CNS Annual Meeting.

These studies are a resounding affirmation: a personalized, connectome-informed definition of eloquence is the future of neurosurgery pre-operative planning and post-operative prognostication.