Advances in neuroimaging and intraoperative mapping have transformed brain tumour surgery from anatomy-based resection to function-guided intervention. This review synthesises current evidence on multimodal strategies for maximising tumour removal while preserving cognitive and neurological function. Integrating task-based and resting-state functional MRI (fMRI), diffusion tensor imaging (DTI), tractography, and connectomic analysis enables personalised mapping of eloquent and cognitive networks. Intraoperatively, awake craniotomy with direct electrical stimulation (DES) remains the gold standard for real-time functional validation, while adjuncts such as intraoperative MRI (iMRI), 5-aminolevulinic acid (5-ALA) fluorescence, and ultrasound-based extended resection accuracy. However, these technologies present unique limitations, including neurovascular uncoupling in fMRI, tract distortion in DTI, and resource constraints in low-income settings. Our review differentiates their application across low-grade and high-grade gliomas, emphasising that tumour biology determines the balance between neuroplasticity-driven mapping and imaging-guided radicality. Key future priorities include validation of multimodal imaging protocols, integration of longitudinal neuropsychological outcomes, and development of interpretable connectomic models. Addressing the technological and ethical challenges of high-field MRI, data standardisation, and cost-effective implementation will be essential for equitable global adoption. Ultimately, the evolution of functional neurosurgery depends not only on new technologies but on integrating multimodal evidence and patient-centred outcome measures to achieve reproducible, safe, and personalised brain tumour surgery.
神经影像学和术中定位技术的进步，已将脑肿瘤手术从基于解剖结构的切除转变为功能引导下的干预。本综述整合了当前关于最大化切除肿瘤同时保留认知与神经功能的多模态策略证据。通过整合任务态与静息态功能磁共振成像（fMRI）、弥散张量成像（DTI）、纤维束示踪及连接组学分析，能够实现对关键功能区及认知网络的个性化定位。术中，清醒开颅联合直接电刺激（DES）仍是实时功能验证的金标准，而术中磁共振（iMRI）、5-氨基乙酰丙酸（5-ALA）荧光引导及超声等辅助技术进一步提升了切除精度。然而，这些技术也存在独特局限，如fMRI中的神经血管解耦、DTI中的纤维束变形，以及低收入环境下的资源限制。本综述区分了这些技术在低级别与高级别胶质瘤中的应用，强调肿瘤生物学特性决定了神经可塑性引导的定位与影像引导的根治性之间的平衡。未来的关键重点包括验证多模态成像方案、整合纵向神经心理学结局，以及开发可解释的连接组学模型。应对高场强磁共振的技术与伦理挑战、数据标准化及成本效益实施，将是实现全球公平推广的关键。最终，功能神经外科的发展不仅依赖于新技术，更需整合多模态证据和以患者为中心的结局指标，以实现可重复、安全且个性化的脑肿瘤手术。
肿瘤(癌症)患者之家