TUMORS NEAR FUNCTIONAL NETWORKs (MOTOR, LANGUAGE, SMA)

Connectomics-Guided Surgery • Awake Mapping • Precision Techniques to Preserve Function

Overview

Tumors that arise within or near functional brain networks—including areas responsible for movement, language, sensation, and executive function—require highly individualized planning. Traditional “location-based” neurosurgery can underestimate the complexity of these lesions because each person’s network layout is unique.

As a leading neurosurgical oncologist and Director of Northwell Health’s Brain & Spine Metastasis Program, Dr. Randy S. D’Amico specializes in the surgical management of tumors in or near eloquent cortex and subcortical pathways. He is one of the few neurosurgeons in the country using structural and functional connectomics, awake mapping, and network-preserving techniques to safely remove tumors while minimizing the risk of permanent neurological deficits.

Patients come to Dr. D’Amico from across New York City and the tri-state area for second opinions—especially when their tumors have been labeled inoperable, “high-risk,” or “not safely resectable.”

What Are “Functional Networks”?

Functional networks are interconnected brain systems responsible for:

Motor Function

  • Movement

  • Coordination

  • Hand dexterity

  • Leg control

Language

  • Speech production

  • Word finding

  • Comprehension

Supplementary Motor Area (SMA)

  • Movement initiation

  • Speech initiation

  • Bimanual coordination

  • Sequencing of actions

Executive & Cognitive Functions

  • Planning

  • Attention

  • Memory

  • Multitasking

Tumors in these regions require strategies that protect both cortical regions and the deeper white-matter tracts that enable communication between them.

Common Tumors in Functional Areas

  • Glioma (low-grade and high-grade)

  • Glioblastoma

  • Metastases

  • Meningiomas near motor/language areas

  • Cavernous malformations

  • Recurrent tumors causing distortion of networks

  • SMA tumors (common for temporary postoperative SMA syndrome)

Each requires a nuanced plan that balances maximal resection with functional preservation.

Symptoms

Depending on location, symptoms may include:

Motor Area Tumors

  • Weakness

  • Loss of coordination

  • Difficulty using hand or arm

  • Leg heaviness or gait disturbance

Language Area Tumors

  • Word-finding difficulty

  • Slowed speech

  • Trouble understanding language

  • Naming or repetition problems

SMA Region Tumors

  • Difficulty initiating movement

  • Trouble starting speech

  • Slowed bimanual tasks

  • Temporary postoperative SMA syndrome symptoms

Early diagnosis and tailored planning can dramatically influence outcomes.

Evaluation & Advanced Imaging

Dr. D’Amico incorporates multiple tools to define each patient’s unique functional map:

  • Functional MRI (fMRI)

  • Diffusion tensor imaging (DTI)

  • Individualized connectomics (structural + functional)

  • Resting-state network analysis

  • Neurocognitive assessment

  • Awake mapping preparation

This provides a detailed blueprint of how the tumor interacts with each network.

Surgical Approach

1. Connectomics-Guided Planning

Connectomics allows Dr. D’Amico to map:

  • Motor pathways (corticospinal tract)

  • Language networks (AF, SLF, IFOF, ILF)

  • SMA circuits

  • Executive networks

  • Default mode and attention networks

This identifies safe corridors, predicts risk, and informs patient-specific surgical goals.

2. Awake Brain Mapping

For tumors near language or motor regions, awake mapping provides real-time feedback to ensure:

  • Preservation of essential speech functions

  • Avoidance of motor deficits

  • Monitoring of naming, reading, counting, movement, and sometimes executive tasks

3. Subcortical Mapping

Even after cortical mapping, subcortical pathways must be protected.
Mapping helps avoid injury to:

  • Corticospinal tract

  • Arcuate fasciculus

  • Superior longitudinal fasciculus

  • Frontal Aslant tract

  • SMA–motor pathways

4. Minimally Invasive Approaches

Where appropriate:

  • Keyhole craniotomies

  • Tubular corridors

  • Exoscopic visualization

  • Tailored approaches based on connectome maps

5. SMA-Syndrome Aware Techniques

For SMA region tumors, Dr. D’Amico uses strategies that reduce the severity and duration of postoperative SMA syndrome, including:

  • Preservation of specific subcortical loops

  • Intraoperative mapping of initiation pathways

  • Postoperative rehabilitation planning

Recovery & Functional Outcomes

Outcomes depend on tumor type, size, and location, but connectomics-guided surgery aims to:

  • Reduce postoperative deficits

  • Shorten recovery time

  • Improve functional independence

  • Preserve quality of life

  • Enable timely start of adjuvant therapy (radiation/chemo)

Most network-related transient symptoms (especially in SMA tumors) improve over days to weeks.

Second Opinions

Dr. D’Amico frequently evaluates patients who have been told:

  • “Your tumor is inoperable.”

  • “Surgery is too risky.”

  • “You will lose function.”

  • “Mapping is not available.”

With advanced imaging and network science, many of these tumors can be removed safely by a specialized team.

Second opinions are often available quickly.

Serving New York City & the Tri-State Area

Care is based at Lenox Hill Hospital on the Upper East Side of Manhattan (100 E 77th St, New York, NY 10075), with convenient access for patients in:

  • Manhattan

  • Brooklyn

  • Queens

  • Bronx

  • Long Island

  • Westchester

  • Northern New Jersey

Next Steps

If you or a loved one has a tumor near an eloquent or functional brain region:

  • Request a Consultation

  • Seek a Second Opinion

  • Refer a Patient

  • Return to Conditions Treated for more conditions