This study aims to evaluate the impact of preoperative functional magnetic resonance imaging (fMRI) on low grade glioma (LGG) patients’ outcomes and surgical planning. Methods In this retrospective matched cohort study of a single surgeon’s patients, we are comparing two groups of LGG patients (WHO grade II) based on exposure to fMRI. Sixteen LGG patients who underwent fMRI were selected, and 32 control (non-fMRI exposed) patients are being selected through propensity score matching from a pool of 764 brain tumour patients. To assess the impact of fMRI data on clinicians’ decision making process, neurosurgeons within a single centre are completing questionnaires regarding treatment options for each LGG fMRI patient based on clinical data and structural imaging before and after fMRI. Results Within the group of 16 LGG patients who have undergone fMRI studies over a 12-year period, most patients presented with seizures (81 percent), and most lesions were left-sided (81 percent) and frontal (75 percent). Patients underwent either craniotomy (50 percent), stereotactic biopsy (25 percent) or nonsurgically management (25 percent). In surgical patients, between presurgical assessment and eight week post-surgical follow-up, mean modified Rankin scale improved from 1.80 (sd 0.79) to 1.50 (sd 0.97). In our cohort, 5-year mortality was 12.5 percent (mean follow-up duration 5.46 years). Conclusions Data analysis is ongoing with plans to compare relevant patient demographics and outcomes, and to analyse questionnaires to elucidate how surgeons incorporate fMRI data into their therapeutic approach.