Practical Application of Networks in Neurosurgery: Combined 3-Dimensional Printing, Neuronavigation, and Preoperative Surgical Planning

Rafael Romero-Garcia, Yaara Erez, Geoffrey Oliver, Mallory Owen, Sakinah Merali, Anujan Poologaindran, Robert C. Morris, Stephen J. Price, Thomas Santarius, John Suckling, Michael G. Hart

Research output: Contribution to journalArticlepeer-review

12 Scopus citations


Background: A plethora of cutting-edge neuroimaging analyses have been developed and published, yet they have not hitherto been realized as improvements in neurosurgical outcomes. In this paper we propose a novel interface between neuroimaging and neurosurgery for aiding translational research. Our objective is to create a method for applying advanced neuroimaging and network analysis findings to neurosurgery and illustrate its application through the presentation of 2 detailed case vignettes. Methods: This interface comprises a combination of network visualization, 3-dimensional printing, and ex-vivo neuronavigation to enable preoperative planning according to functional neuroanatomy. Clinical cases were selected from a prospective cohort study. Results: The first case vignette describes a low-grade glioma with potential language and executive function network involvement that underwent a successful complete resection of the lesion with preservation of network features. The second case describes a low-grade glioma in an apparently noneloquent location that underwent a subtotal resection but demonstrated unexpected and significant impairment in executive function postoperatively that subsequently abated during follow-up. In both examples the neuroimaging and network data highlight the complexity of the surrounding functional neuroanatomy at the individual level, beyond that which can be perceived on standard structural sequences. Conclusions: The described interface has widespread applications for translational research including preoperative planning, neurosurgical training, and detailed patient counseling. A protocol for assessing its effectiveness and safety is proposed. Finally, recommendations for effective translation of findings from neuroimaging to neurosurgery are discussed, with the aim of making clinically meaningful improvements to neurosurgical practice.

Original languageEnglish
Pages (from-to)e126-e137
JournalWorld Neurosurgery
StatePublished - May 2020
Externally publishedYes

Bibliographical note

Funding Information:
Conflict of interest statement: RRG is funded by a Guarantors of Brain Post-Doctoral Fellowship award. YE is funded by a Royal Society Dorothy Hodgkin Research Fellowship. AP is funded by an Alan Turing Institute Doctoral Scholarship. SJP received funding through a National Institute for Health Research (NIHR) (UK)−Clinician Scientist Award (ref: NIHR/CS/009/011). MGH received an award from The Brain Tumour Charity (ref: RG86218) to fund this work.

Publisher Copyright:
© 2020 Elsevier Inc.


  • Connectome
  • Functional connectivity
  • Imaging
  • Networks
  • Tractography


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