Cortical–Subcortical Functional Preservation and Rehabilitation in Neuro-Oncology: Tractography-MIPS-IONM-TMS Proof-of-Concept Study

Surgical management of deep-seated brain tumors requires precise functional navigation and minimally invasive surgery. Preoperative mapping using navigated transcranial magnetic stimulation (nTMS), intraoperative neurophysiological monitoring (IONM), parafascicular surgery (MIPS) act together in a functional-sparing approach. nTMS also provides rehabilitation tool to maximize recovery. This is single-center retrospective proof-of-concept cohort study between January 2022 June 2023 patients admitted for with motor eloquent tumors. The enrolled seven adult patients, five females two males, mean age 56.28 years old. lesions were located the cingulate gyrus (three patients), central core (two basal ganglia patients). All had preoperative deficits. most common histological diagnosis was metastasis (five MIPS approach mid-cingulate involved trajectory through fronto-aslant tract (FAT) fronto-striatal (FST). No positive responses resected as part outer corridor MIPS. Direct cortical produced stable motor-evoked potentials during surgeries no warning signs. Gross total resection (GTR) achieved three near-total (NTR) four patients. Post-operatively, all deterioration function ischemia postoperative imaging (cavity-to-CST distance 0–4 mm). After low-frequency contralateral cortex, six recovered their status one patient improved better condition. A combined Tractography-MIPS-IONM-TMS successful framework recovery after