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fMRI is becoming an important clinical tool for planning and guidance of surgery to treat brain tumors, arteriovenous malformations, and epileptic foci. For visual cortex mapping, the most popular paradigm by far is temporal phase mapping, although random multifocal stimulation paradigms have drawn increased attention due to their ability to identify complex response fields and their random properties. In this study we directly compared temporal phase and multifocal vision mapping paradigms with respect to clinically relevant factors including: time efficiency, mapping completeness, and the effects of noise. Randomized, multifocal mapping accurately decomposed the response of single voxels to multiple stimulus locations and made correct retinotopic assignments as noise levels increased despite decreasing sensitivity. Also, multifocal mapping became less efficient as the number of stimulus segments (locations) increased from 13 to 25 to 49 and when duty cycle was increased from 25% to 50%. Phase mapping, on the other hand, activated more extrastriate visual areas, was more time efficient in achieving statistically significant responses, and had better sensitivity as noise increased, though with an increase in systematic retinotopic mis-assignments. Overall, temporal phase mapping is likely to be a better choice for routine clinical applications though random multifocal mapping may offer some unique advantages for selected applications.