Impact of Preoperative fMRI and DTI on Neurosurgical Planning for Brain Tumors: A Multi-Institutional Survey Study

Background and purpose This multi-institutional study investigates how preoperative fMRI and DTI influence surgical decision-making and clinical outcomes in patients undergoing brain tumor resection.Materials and methods Seventy patients from 4 academic centers underwent preoperative task-based fMRI and DTI: Thomas Jefferson University (TJU), n = 51; University Hospital Basel, n=12; University of Pennsylvania (UPenn), n = 4; and Johns Hopkins University (JHU), n=3. Six neurosurgeons completed structured pre- and postimaging surveys evaluating changes in surgical approach, craniotomy planning, extent of resection, operative duration, and diagnostic confidence.Results Integration of fMRI and DTI into surgical planning resulted in a noteworthy shift from awake to asleep craniotomies, especially at TJU (P = .01), with "asleep" craniotomy increasing to 51% overall (χ2: P P Conclusions Preoperative fMRI and DTI significantly reshape neurosurgical planning by optimizing resection strategies. Most notably, preoperative mapping facilitated a significant shift from awake to asleep craniotomies, contributing to shorter-than-expected surgical durations without compromising the extent of resection.