A Comparison of Language Mapping by Preoperative Navigated Transcranial Magnetic Stimulation and Direct Cortical Stimulation During Awake Surgery

Picht, Thomas; Krieg, Sandro M.; Sollmann, Nico; Rösler, Judith; Niraula, Birat; Neuvonen, Tuomas; Savolainen, Petri; Lioumis, Pantelis; Mäkelä, Jyrki P.; Deletis, Vedran; Meyer, Bernhard; Vajkoczy, Peter; Ringel, Florian

doi:10.1227/neu.0b013e3182889e01

Cited by 276 publications

(373 citation statements)

References 49 publications

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“…One of its earliest uses as a "virtual lesion" technique was to induce speech arrest by stimulating the left inferior frontal cortex [16][17][18] . The results confirmed the importance of Broca's area for speech production and suggested a potential alternative to Wada testing to determine language dominance subsequent to neurosurgical interventions 16,19 . Now TMS is used in virtually all areas of cognitive neuroscience including attention 20 , memory 21 , visual processing 22 , action planning 23 , decision making 24 , and language processing 25 .…”

Section: Introductionsupporting

confidence: 64%

Transcranial Magnetic Stimulation for Investigating Causal Brain-behavioral Relationships and their Time Course

Śliwińska

Vitello

Devlin

2014

JoVE

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Transcranial magnetic stimulation (TMS) is a safe, non-invasive brain stimulation technique that uses a strong electromagnet in order to temporarily disrupt information processing in a brain region, generating a short-lived "virtual lesion." Stimulation that interferes with task performance indicates that the affected brain region is necessary to perform the task normally. In other words, unlike neuroimaging methods such as functional magnetic resonance imaging (fMRI) that indicate correlations between brain and behavior, TMS can be used to demonstrate causal brain-behavior relations. Furthermore, by varying the duration and onset of the virtual lesion, TMS can also reveal the time course of normal processing. As a result, TMS has become an important tool in cognitive neuroscience. Advantages of the technique over lesion-deficit studies include better spatial-temporal precision of the disruption effect, the ability to use participants as their own control subjects, and the accessibility of participants. Limitations include concurrent auditory and somatosensory stimulation that may influence task performance, limited access to structures more than a few centimeters from the surface of the scalp, and the relatively large space of free parameters that need to be optimized in order for the experiment to work. Experimental designs that give careful consideration to appropriate control conditions help to address these concerns. This article illustrates these issues with TMS results that investigate the spatial and temporal contributions of the left supramarginal gyrus (SMG) to reading.

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Section: Introductionsupporting

confidence: 64%

Transcranial Magnetic Stimulation for Investigating Causal Brain-behavioral Relationships and their Time Course

Śliwińska

Vitello

Devlin

2014

JoVE

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“…18,19,40,48,69,80 Its clinical applicability and correlation to DCS during awake surgery have repeatedly been shown as well. 36,37,51,68,75 Although rTMS language mapping has already experienced some improvement, 40 the standard for preoperative, noninvasive language mapping remains functional MRI (fMRI). 21 Yet this technique, though well established, has failed to provide reliable preoperative language mapping, showing only minor correlation with intraoperative DCS.…”

mentioning

confidence: 99%

Combined noninvasive language mapping by navigated transcranial magnetic stimulation and functional MRI and its comparison with direct cortical stimulation

Ille

Sollmann

Hauck

et al. 2015

JNS

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100

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T he resection of tumors within or adjacent to language-eloquent brain regions is still a neurosurgical quest, and a profound presurgical workup is crucial to achieving the best functional and oncological result. 6,71 Today, the most precise way to localize individual language-eloquent regions is direct cortical stimulation (DCS) during awake craniotomy. 9,12,26,44,45,54,62,65,74 Using only DCS, however, we cannot provide the longitudinal abbreviatioNs BOLD = blood oxygen level-dependent; CPS = cortical parcellation system; DCS direct cortical stimulation; ER = error rate; ERT error rate threshold; fMRI = functional MRI; IPI = interpicture interval; NPV = negative predictive value; nTMS navigated TMS; PPV = positive predictive value; PTI = picture-to-trigger interval; RMT = resting motor threshold; ROC = receiver operating characteristic; rTMS repetitive navigated TMS; TMS = transcranial magnetic stimulation. obJect Repetitive navigated transcranial magnetic stimulation (rTMS) is now increasingly used for preoperative language mapping in patients with lesions in language-related areas of the brain. Yet its correlation with intraoperative direct cortical stimulation (DCS) has to be improved. To increase rTMS's specificity and positive predictive value, the authors aim to provide thresholds for rTMS's positive language areas. Moreover, they propose a protocol for combining rTMS with functional MRI (fMRI) to combine the strength of both methods. methods The authors performed multimodal language mapping in 35 patients with left-sided perisylvian lesions by using rTMS, fMRI, and DCS. The rTMS mappings were conducted with a picture-to-trigger interval (PTI, time between stimulus presentation and stimulation onset) of either 0 or 300 msec. The error rates (ERs; that is, the number of errors per number of stimulations) were calculated for each region of the cortical parcellation system (CPS). Subsequently, the rTMS mappings were analyzed through different error rate thresholds (ERT; that is, the ER at which a CPS region was defined as language positive in terms of rTMS), and the 2-out-of-3 rule (a stimulation site was defined as language positive in terms of rTMS if at least 2 out of 3 stimulations caused an error). As a second step, the authors combined the results of fMRI and rTMS in a predefined protocol of combined noninvasive mapping. To validate this noninvasive protocol, they correlated its results to DCS during awake surgery. results The analysis by different rTMS ERTs obtained the highest correlation regarding sensitivity and a low rate of false positives for the ERTs of 15%, 20%, 25%, and the 2-out-of-3 rule. However, when comparing the combined fMRI and rTMS results with DCS, the authors observed an overall specificity of 83%, a positive predictive value of 51%, a sensitivity of 98%, and a negative predictive value of 95%. coNclusioNs In comparison with fMRI, rTMS is a more sensitive but less specific tool for preoperative language mapping than DCS. Moreover, rTMS is most reliable when using ERTs of 15%, 20...

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“…In addition, navigated transcranial magnetic stimulation (nTMS) is increasingly used in presurgical brain mapping. Preoperative nTMS results correlate well with direct cortical stimulation (DCS) data in the identification of the primary motor cortex [8].…”

Section: Introductionmentioning

confidence: 65%

Presurgical Mapping of Brain Tumors Using Statistical Probabilistic Anatomical Maps

Kim¹,

Cheon²,

Lim³

2015

JBiSE

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Purpose: Multi-tracer neuroimaging is widely used for the diagnosis, radiotherapy, and neurosurgery of brain gliomas. Anatomical and functional information is important to avoid having neurological deficits induced during the resection or radiation therapy of brain gliomas. The aim of this study was to investigate presurgical anatomical labeling of brain gliomas on FLT and FET using statistical probabilistic anatomic maps (SPAM), which are images of cerebral cortical, cerebellar, and subcortical volumes of interest (VOIs). Methods: FDG, FLT, and FET PET scans were acquired. FLT and FET PET images were coregistered to the FDG PET images, which were then spatially normalized onto the target brain. An inverse spatial normalization parameter was calculated and applied to SPAM. For the anatomical labeling of brain glioma regions, the volumes of brain gliomason FLT and FET images were extracted using segmentation. Probabilistic information of the glioma region was then calculated using SPAM and the segmented glioma volumes. SPM and an in-house program were used for image processing. Results: The probability of SPAM labeling a brain glioma region could be extracted using the inverse normalized SPAM and segmented glioma regions. In a sample case, the probabilistic anatomical region of the glioma included 21% of the postcentral gyrus, 12% of the superior parietal gyrus, and 6% of the angular gyrus. Conclusion: Anatomical information about brain gliomas could be extracted using SPAM. This proposed method would be optional for presurgical mapping, to avoid an additional functional mapping study that might otherwise be necessary to avoid producing neurological deficits.

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A Comparison of Language Mapping by Preoperative Navigated Transcranial Magnetic Stimulation and Direct Cortical Stimulation During Awake Surgery

Cited by 276 publications

References 49 publications

Transcranial Magnetic Stimulation for Investigating Causal Brain-behavioral Relationships and their Time Course

Transcranial Magnetic Stimulation for Investigating Causal Brain-behavioral Relationships and their Time Course

Combined noninvasive language mapping by navigated transcranial magnetic stimulation and functional MRI and its comparison with direct cortical stimulation

Presurgical Mapping of Brain Tumors Using Statistical Probabilistic Anatomical Maps

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