Feasibility of nTMS-based DTI fiber tracking of language pathways in neurosurgical patients using a fractional anisotropy threshold

Sollmann, Nico; Negwer, Chiara; Ille, Sebastian; Maurer, Stefanie; Hauck, Theresa; Kirschke, Jan S.; Ringel, Florian; Meyer, Bernhard; Krieg, Sandro M.

doi:10.1016/j.jneumeth.2016.04.002

Cited by 38 publications

(47 citation statements)

References 52 publications

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“…Moreover, the combination of rTMS-positive cortical spots with tractography of subcortical language pathways via diffusion tensor imaging fiber tracking (DTI-FT) can aid in the interpretation of the results and add important information pertaining to the location of relevant cortical and subcortical structures. Protocols for rTMS-based DTI-FT have been described and compared to existing protocols [24,40].…”

Section: Utilization Of Mapping Data For Surgical Planningmentioning

confidence: 99%

Protocol for motor and language mapping by navigated TMS in patients and healthy volunteers; workshop report

et al. 2017

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Section: Utilization Of Mapping Data For Surgical Planningmentioning

confidence: 99%

Protocol for motor and language mapping by navigated TMS in patients and healthy volunteers; workshop report

et al. 2017

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“…TMS cannot map the subcortical white matter fiber tracts that need to be identified with intraoperative DES. However, the combined use of nTMS and tractography has been recently described to obtain a preoperative mapping of the language network [28,36,38]. Having a preoperative map of the functional boundaries depicted by nTMS then leads to a shorter intraoperative procedure [31], a more targeted craniotomy [37] and more confidence in decision making for the surgical team.…”

Section: Navigated Transcranial Magnetic Stimulationmentioning

confidence: 99%

The verb and noun test for peri-operative testing (VAN-POP): standardized language tests for navigated transcranial magnetic stimulation and direct electrical stimulation

et al. 2019

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Background Protocols for intraoperative language mapping with direct electrical stimulation (DES) often include various language tasks triggering both nouns and verbs in sentences. Such protocols are not readily available for navigated transcranial magnetic stimulation (nTMS), where only single word object naming is generally used. Here, we present the development, norming, and standardization of the verb and noun test for peri-operative testing (VAN-POP) that measures language skills more extensively. Methods The VAN-POP tests noun and verb retrieval in sentence context. Items are marked and balanced for several linguistic factors known to influence word retrieval. The VAN-POP was administered in English, German, and Dutch under conditions that are used for nTMS and DES paradigms. For each language, 30 speakers were tested. Results At least 50 items per task per language were named fluently and reached a high naming agreement. Conclusion The protocol proved to be suitable for pre-and intraoperative language mapping with nTMS and DES.

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“…Nevertheless, this remains an arbitrary value selection which neither takes the interindividual patient characteristics into account nor the different types of fiber tracts (e.g., CST or language pathways). Furthermore, there currently exists contention concerning the ambiguity of the standardized values (i.e., 75%-, 50%-or 25%-FAT) to be used (Sollmann et al, 2016;Weiss Lucas et al, 2017). The proposed neurophysiology-driven approach for FA and FL threshold selection not only chooses the threshold parameters in a completely user-independent manner, but also considers the differences between patients.…”

Section: Discussionmentioning

confidence: 99%

Neurophysiology-Driven Parameter Selection in nTMS-Based DTI Tractography: A Multidimensional Mathematical Model

et al. 2019

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Object: There is an increasing interest in preoperative diffusion tensor imaging-based fiber tracking (DTI-FT) to preserve function during surgeries in motor eloquent brain regions. However, DTI tractography is challenged by inherent presumptions during particular tracking steps [e.g., deterministic vs. probabilistic DTI, fractional anisotropy (FA) and fiber length (FL) thresholding] and the missing "ground truth" information. In the present study, we intended to establish an objective, neurophysiology-driven approach for parameter selection during DTI-FT of the corticospinal tract integrating both imaging and neurophysiological information. Methods: In ten patients with lesions in eloquent motor areas, preoperative navigated transcranial magnetic stimulation (nTMS) was performed, followed by individual deterministic DTI-FT from a grid of cortical seed points. We investigated over 300 combinations of FA and FL thresholds and applied subsequently a multidimensional mathematical modeling of this empirical data. Optimal DTI parameters were determined by the relationship between DTI-FT (i.e., number of fibers, NoF) and nTMS (i.e., amplitudes of motor-evoked potentials) results. Finally, neurophysiological DTI parameters and the resulting tractography were compared to the current standard approaches of deterministic DTI fiber tracking with a 75% and 50% FA and a FL threshold of 110 mm as well as with intraoperative direct cortical and subcortical stimulation. Results: There was a good goodness-of-fit for the mathematical model (r 2 = 0.68 ± 0 13; range: 0.59-0.97; n = 8) except of two cases. Neurophysiology-driven parameter selection showed a high correlation between DTI-FT and nTMS results (r = 0.73 ± 0.16; range: 0.38-0.93). In comparison to the standard approach, the mathematically calculated thresholds resulted in a higher NoF in 75% of patients. In 50% of patients

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Feasibility of nTMS-based DTI fiber tracking of language pathways in neurosurgical patients using a fractional anisotropy threshold

Cited by 38 publications

References 52 publications

Protocol for motor and language mapping by navigated TMS in patients and healthy volunteers; workshop report

Protocol for motor and language mapping by navigated TMS in patients and healthy volunteers; workshop report

The verb and noun test for peri-operative testing (VAN-POP): standardized language tests for navigated transcranial magnetic stimulation and direct electrical stimulation

Neurophysiology-Driven Parameter Selection in nTMS-Based DTI Tractography: A Multidimensional Mathematical Model

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