First United Kingdom Experience of Navigated Transcranial Magnetic Stimulation in Preoperative Mapping of Brain Tumors

Jung, Josephine; Lavrador, José-Pedro; Patel, Sabina; Giamouriadis, Anastasios; Lam, Jørgen; Bhangoo, Ranjeev; Ashkan, Keyoumars; Vergani, Francesco

doi:10.1016/j.wneu.2018.11.114

Cited by 46 publications

(36 citation statements)

References 53 publications

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“…Recently, some authors demonstrated the usefulness of rTMS language mapping especially in patients not eligible for awake surgery; 20,24,52,56 a few other studies analyzed the impact of this approach in patients operated on using awake surgery. 22,27,62,69,71 Conclusions from all these studies were in accord that nTMS-based language mapping enables a reliable identification of the language network, and allows for a tailored surgical strategy that may result in a good functional and even oncological outcome. Nevertheless, literature evidence currently consists of observational studies only, and no randomized clinical trials have been either organized or published so far.…”

Section: Neurosurgical Use-current Evidencementioning

confidence: 66%

When imaging meets neurophysiology: the value of navigated transcranial magnetic stimulation for preoperative neurophysiological mapping prior to brain tumor surgery

Raffa

Quattropani

Germanò

2019

Neurosurgical Focus

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Maximal safe resection is the modern goal for surgery of intrinsic brain tumors located in or close to brain eloquent areas. Nowadays different neuroimaging techniques provide important anatomical and functional information regarding the brain functional organization that can be used to plan a customized surgical strategy to preserve functional networks, and to increase the extent of tumor resection. Among these techniques, navigated transcranial magnetic stimulation (nTMS) has recently gained great favor among the neurosurgical community for preoperative mapping and planning prior to brain tumor surgery. It represents an advanced neuroimaging technique based on the neurophysiological mapping of the functional cortical brain organization. Moreover, it can be combined with other neuroimaging techniques such as diffusion tensor imaging tractography, thus providing a reliable reconstruction of brain eloquent networks. Consequently, nTMS mapping may provide reliable noninvasive brain functional mapping, anticipating information that otherwise may be available to neurosurgeons only in the operating theater by using direct electrical stimulation. The authors describe the reliability and usefulness of the preoperative nTMS-based approach in neurosurgical practice, and briefly discuss their experience using nTMS as well as currently available evidence in the literature supporting its clinical use. In particular, special attention is reserved for the discussion of the role of nTMS as a novel tool for the preoperative neurophysiological mapping of motor and language networks prior to surgery of intrinsic brain tumors located in or close to eloquent networks, as well as for future and promising applications of nTMS in neurosurgical practice.

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Section: Neurosurgical Use-current Evidencementioning

confidence: 66%

When imaging meets neurophysiology: the value of navigated transcranial magnetic stimulation for preoperative neurophysiological mapping prior to brain tumor surgery

Raffa

Quattropani

Germanò

2019

Neurosurgical Focus

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“…Through nTMS it is possible to accurately map eloquent and motor areas using magnetic stimulation. nTMS can significantly reduce surgical time and guarantee a better functional outcome if coupled intraoperatively with DES ( 41 ). fMRI, nTMS, and DES guarantee a continuous control of motor, sensory or language domains on awake patients, thus ensuring a more radical excision according to functional boundaries ( 42 ).…”

Section: Discussionmentioning

confidence: 99%

Brain Mapping-Aided SupraTotal Resection (SpTR) of Brain Tumors: The Role of Brain Connectivity

et al. 2021

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Brain gliomas require a deep knowledge of their effects on brain connectivity. Understanding the complex relationship between tumor and functional brain is the preliminary and fundamental step for the subsequent surgery. The extent of resection (EOR) is an independent variable of surgical effectiveness and it correlates with the overall survival. Until now, great efforts have been made to achieve gross total resection (GTR) as the standard of care of brain tumor patients. However, high and low-grade gliomas have an infiltrative behavior and peritumoral white matter is often infiltrated by tumoral cells. According to these evidences, many efforts have been made to push the boundary of the resection beyond the contrast-enhanced lesion core on T1w MRI, in the so called supratotal resection (SpTR). SpTR is aimed to maximize the extent of resection and thus the overall survival. SpTR of primary brain tumors is a feasible technique and its safety is improved by intraoperative neuromonitoring and advanced neuroimaging. Only transient cognitive impairments have been reported in SpTR patients compared to GTR patients. Moreover, SpTR is related to a longer overall and progression-free survival along with preserving neuro-cognitive functions and quality of life.

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“…Preoperative mapping of the primary motor cortex was performed with nTMS, according to the protocol previously described by our group using Nexstim, v.4.3.1 (Nexstim, Helsinki, Finland). 2 Briefly, a single-pulse sequence was delivered using a figure-of-eight coil, and the motor mapping was performed at 105% of the determined resting motor threshold (lowest stimulation intensity capable of eliciting a motor evoked potential [MEP]).…”

Section: Methodsmentioning

confidence: 99%

“…In the last decade, nTMS has emerged for preoperative brain mapping in patients with tumors in motor and language-eloquent areas. 2,[11][12][13] The nTMS uses a figure-ofeight stimulation coil, matched with neuronavigation, to deliver biphasic magnetic stimulation to the cortex. Singlepulse nTMS, applied to the primary motor cortex, generates muscle output that is recorded via a continuously running electromyogram.…”

Section: Introductionmentioning

confidence: 99%

Pre- and Intraoperative Mapping for Tumors in the Primary Motor Cortex: Decision-Making Process in Surgical Resection

Lavrador

Ghimire

Brogna

et al. 2020

J Neurol Surg A Cent Eur Neurosurg

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Background Lesions within the primary motor cortex (M1) and the corticospinal tract (CST) represent a significant surgical challenge with a delicate functional trade-off that should be integrated in the overall patient-centered treatment plan. Methods Patients with lesions within the M1 and CST with preoperative cortical and subcortical mapping (navigated transcranial magnetic stimulation [nTMS] and tractography), intraoperative mapping, and intraoperative provisional histologic information (smear with and without 5-aminolevulinic acid [5-ALA]) were included. This independently acquired information was integrated in a decision-making process model to determine the intraoperative extent of resection. Results A total of 10 patients (6 patients with metastatic precentral tumor; 1 patient with grade III and 2 patients with grade IV gliomas; 1 patient with precentral cavernoma) were included in the study. Most of the patients (60%) had a preoperative motor deficit. The nTMS documented M1 invasion in all cases, and in eight patients, the lesions were embedded within the CST. Overall, 70% of patients underwent gross total resection; 20% of patients underwent near-total resection of the lesions. In only one patient was no surgical resection possible after both preoperative and intraoperative mapping. Overall, 70% of patients remained stable postoperatively, and previous motor weakness improved in 20%. Conclusion The independently acquired anatomical (anatomical MRI) and functional (nTMS and tractography) tests in patients with CST lesions provide a useful guide for resection. The inclusion of histologic information (smear with or without 5-ALA) further allows the surgical team to balance the potential functional risks within the global treatment plan. Therefore, the patient is kept at the center of the informed decision-making process.

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First United Kingdom Experience of Navigated Transcranial Magnetic Stimulation in Preoperative Mapping of Brain Tumors

Cited by 46 publications

References 53 publications

When imaging meets neurophysiology: the value of navigated transcranial magnetic stimulation for preoperative neurophysiological mapping prior to brain tumor surgery

When imaging meets neurophysiology: the value of navigated transcranial magnetic stimulation for preoperative neurophysiological mapping prior to brain tumor surgery

Brain Mapping-Aided SupraTotal Resection (SpTR) of Brain Tumors: The Role of Brain Connectivity

Pre- and Intraoperative Mapping for Tumors in the Primary Motor Cortex: Decision-Making Process in Surgical Resection

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