In Reply to the Letter to the Editor Regarding “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.2019.01.288

World Neurosurgery

2019

DOI: 10.1016/j.wneu.2019.01.288

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In Reply to the Letter to the Editor Regarding “First United Kingdom Experience of Navigated Transcranial Magnetic Stimulation in Preoperative Mapping of Brain Tumors”

Josephine Jung

José-Pedro Lavrador

Sabina Patel

et al.

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“…16,17 Navigated transcranial magnetic stimulation (nTMS) has been introduced in the last decade to noninvasively map the primary motor cortex for presurgical planning in patients with brain tumors. 5,[18][19][20] By stimulating the primary motor cortex, motor evoked potentials (MEPs) are elicited in peripheral muscles, and their latency and amplitude can be estimated. nTMS is also useful in defining the resting motor threshold (rMT) of the primary motor cortex.…”

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Altered corticospinal microstructure and motor cortex excitability in gliomas: an advanced tractography and transcranial magnetic stimulation study

Mirchandani

Beyh

Lavrador

et al. 2021

Journal of Neurosurgery

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OBJECTIVEThis prospective case-control study was conducted to examine whether spherical deconvolution (SD) can unveil microstructural abnormalities in the corticospinal tract (CST) caused by IDH-mutant gliomas. To determine the significance of abnormal microstructure, the authors investigated the correlation between diffusion parameters and neurophysiological data collected with navigated transcranial magnetic stimulation (nTMS).METHODSTwenty participants (10 patients and 10 healthy controls) were recruited. Diffusion-weighted images were acquired on a 3-T MRI scanner using a cardiac-gated single-shot spin echo echo-planar imaging multiband sequence (TE 80 msec, TR 4000 msec) along 90 diffusion directions with a b-value of 2500 sec/mm2 (FOV 256 × 256 mm). Diffusion tensor imaging tractography and SD tractography were performed with deterministic tracking. The anterior portion of the ipsilateral superior peduncle and the precentral gyrus were used as regions of interest to delineate the CST. Diffusion indices were extracted and analyzed for significant differences between hemispheres in patients and between patient and control groups. A navigated brain stimulation system was used to deliver TMS pulses at hotspots at which motor evoked potentials (MEPs) for the abductor pollicis brevis, first digital interosseous, and abductor digiti minimi muscles are best elicited in patients and healthy controls. Functional measurements such as resting motor threshold (rMT), amplitude of MEPs, and latency of MEPs were noted. Significant differences between hemispheres in patients and between patients and controls were statistically analyzed. The Spearman rank correlation was used to investigate correlations between diffusion indices and functional measurements.RESULTSThe hindrance modulated orientational anisotropy (HMOA), measured with SD tractography, is lower in the hemisphere ipsilateral to glioma (p = 0.028). The rMT in the hemisphere ipsilateral to a glioma is significantly greater than that in the contralateral hemisphere (p = 0.038). All measurements contralateral to the glioma, except for the mean amplitude of MEPs (p = 0.001), are similar to those of healthy controls. Mean diffusivity and axial diffusivity from SD tractography are positively correlated with rMT in the hemisphere ipsilateral to glioma (p = 0.02 and 0.006, respectively). The interhemispheric difference in HMOA and rMT is correlated in glioma patients (p = 0.007).CONCLUSIONSSD tractography can demonstrate microstructural abnormality within the CST of patients with IDH1-mutant gliomas that correlates to the functional abnormality measured with nTMS.

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Altered corticospinal microstructure and motor cortex excitability in gliomas: an advanced tractography and transcranial magnetic stimulation study

Mirchandani

Beyh

Lavrador

et al. 2021

Journal of Neurosurgery

Self Cite

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In Reply to the Letter to the Editor Regarding “First United Kingdom Experience of Navigated Transcranial Magnetic Stimulation in Preoperative Mapping of Brain Tumors”

Cited by 1 publication

References 14 publications

Altered corticospinal microstructure and motor cortex excitability in gliomas: an advanced tractography and transcranial magnetic stimulation study

Altered corticospinal microstructure and motor cortex excitability in gliomas: an advanced tractography and transcranial magnetic stimulation study

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