Multimodal Surgical Treatment of High-Grade Gliomas in the Motor Area: The Impact of the Combination of Navigated Transcranial Magnetic Stimulation and Fluorescein-Guided Resection

Raffa, Giovanni; Scibilia, Antonino; Conti, Alfredo; Cardali, Salvatore; Rizzo, Vincenzo; Terranova, Carmen; Quattropani, Maria C.; Marzano, Giuseppina; Ricciardo, Giuseppe; Vinci, Sergio Lucio; Germanò, Antonino

doi:10.1016/j.wneu.2019.04.158

Cited by 30 publications

(19 citation statements)

References 68 publications

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“…The values of RMT and the arachnoidal plane of cleavage were the only predictive variables for the occurrence of motor deficit TMS e IOMN were concordant on the entanglement of the motor area in the tumor in 94.7% of the cases. x Freigang S et al, 2020 34 Figure-of-eight stimulation coil 90% BIPOLAR RMT, amplitude The utilization of a priming protocol led to lesser identification errors compared to the sp-TMS 7 patients reported strong facial muscle contraction Tokarev A S et al, 2020 38 Figure-of-eight stimulation coil 110% x Amplitude, RMT The use of nTMS helps to better map the motor eloquent cortex by reducing the Gy dosage to perform an efficient mapping. x Jung J et al, 2019 48 Figure-of-eight stimulation coil 105% BIPOLAR RMT nTMS changed 10% of the planning.…”

Section: Resultsmentioning

confidence: 99%

“… 33 Additionally, another study showed that patients receiving a multimodal approach (nTMS + sodium fluoride marker) had significantly better motor outcomes compared to those receiving only nTMS. 34 …”

Section: Resultsmentioning

confidence: 99%

“…It let identify the use of navigated TMS, direct cortical stimulation in different centers, showing excellent accuracy for motor mapping with significant improvement in surgical results. 6 , 8 , 10 , 13 , 34 , 44 , 50 , 54–57 …”

Section: Discussionmentioning

confidence: 99%

“… 73 Further, two studies investigating the use of sodium fluorescein to help guide the TMS showed that using this multimodal approach could promote significant reduction in the occurrence of postoperative motor deficits when compared to the use of just intraoperative monitoring. 34 , 74 …”

Section: Discussionmentioning

confidence: 99%

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Assessing the Capabilities of Transcranial Magnetic Stimulation (TMS) to Aid in the Removal of Brain Tumors Affecting the Motor Cortex: A Systematic Review

Schiavao¹,

Neville²,

Hayashi³

et al. 2022

NDT

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Introduction The brain tumor is frequently related to severe motor impairment and impacts the quality of life. The corticospinal tract can sometimes be affected depending on the type and size of the neoplasm, so different tools can evaluate motor function and connections. It is essential to organize surgical procedures and plan the approach. Functional motor status is mapped before, during, and after surgery. Studying corticospinal tract status can help map the functional areas, predict postoperative outcomes, and help the decision, reducing neurological deficits, aiming to preserve functional networks, using the concepts of white matters localization and fibbers connections. Nowadays, there are new techniques that provide functional information regarding the motor cortex, such as transcranial magnetic stimulation (TMS), direct cortical stimulation (DCS), and navigated TMS (nTMS). These tools can be used to plan a customized surgical strategy and the role of motor evoked potentials (MEPs) is well described during intra-operative, using intraoperative neuromonitoring. MEPs can help to localize primary motor areas and delineate the cut-off point of resection in real-time, using direct stimulation. In the post-operative, the MEP has increased your function as a predictive marker of permanent or transitory neurological lesion marker. Methods Systematic review performed in MEDLINE via PUBMED, EMBASE, and SCOPUS databases regarding the post-operative assessment of MEP in patients with brain tumors. The search strategy included the following terms: ((“Evoked Potentials, Motor”[Mesh]) AND “Neoplasms”[Mesh]) AND “Transcranial Magnetic Stimulation”[Mesh] AND “Brain Tumor”[Mesh]), the analysis followed the PRISMA guidelines for systematic reviews, the review spanned until 06/04/2021, inclusion criteria were studies presenting confirmed diagnosis of brain tumor (primary or metastatic), patients >18 y/o, using TMS, Navigated TMS, and/or Evoked Potentials as tools in preoperative planning or at the intra-operative helping the evaluation of the neurological status of the motor cortex, articles published in peer-reviewed journals, and written in English or Portuguese. Results A total of 38 studies were selected for this review, of which 14 investigated the potential of nTMS to predict the occurrence of motor deficits, while 25 of the articles investigated the capabilities of the nTMS technique in performing pre/intraoperative neuro mapping of the motor cortex. Conclusion Further studies regarding motor function assessment are needed and standardized protocols for MEPs also need to be defined.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Assessing the Capabilities of Transcranial Magnetic Stimulation (TMS) to Aid in the Removal of Brain Tumors Affecting the Motor Cortex: A Systematic Review

Schiavao¹,

Neville²,

Hayashi³

et al. 2022

NDT

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show abstract

“…In 47 patients with MEN located in the rolandic area, nTMS motor mapping and tractography facilitated a modification of the surgical strategy in 42.5% of cases, and a new permanent motor deficit (i.e., deficit that did not resolve to the preoperative status within the follow-up interval) occurred in 8.5% of cases, which is at the lower edge of the range for motor deficits known from the literature of the pre-nTMS era [ 65 ]. Furthermore, the combination of sodium fluorescein-guided resection (FGR) with preoperative nTMS motor mapping and tractography has been explored recently, revealing a higher GTR rate for patients operated on using nTMS and FGR as well as lower rates of new surgery-related permanent motor deficits when compared with controls [ 66 , 67 ].…”

Section: Clinical Application Of Ntms For Mapping Motor Functionmentioning

confidence: 99%

Mapping of Motor Function with Neuronavigated Transcranial Magnetic Stimulation: A Review on Clinical Application in Brain Tumors and Methods for Ensuring Feasible Accuracy

et al. 2021

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Navigated transcranial magnetic stimulation (nTMS) has developed into a reliable non-invasive clinical and scientific tool over the past decade. Specifically, it has undergone several validating clinical trials that demonstrated high agreement with intraoperative direct electrical stimulation (DES), which paved the way for increasing application for the purpose of motor mapping in patients harboring motor-eloquent intracranial neoplasms. Based on this clinical use case of the technique, in this article we review the evidence for the feasibility of motor mapping and derived models (risk stratification and prediction, nTMS-based fiber tracking, improvement of clinical outcome, and assessment of functional plasticity), and provide collected sets of evidence for the applicability of quantitative mapping with nTMS. In addition, we provide evidence-based demonstrations on factors that ensure methodological feasibility and accuracy of the motor mapping procedure. We demonstrate that selection of the stimulation intensity (SI) for nTMS and spatial density of stimuli are crucial factors for applying motor mapping accurately, while also demonstrating the effect on the motor maps. We conclude that while the application of nTMS motor mapping has been impressively spread over the past decade, there are still variations in the applied protocols and parameters, which could be optimized for the purpose of reliable quantitative mapping.

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Comparing navigated transcranial magnetic stimulation mapping and “gold standard” direct cortical stimulation mapping in neurosurgery: a systematic review

et al. 2020

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The objective of this systematic review is to create an overview of the literature on the comparison of navigated transcranial magnetic stimulation (nTMS) as a mapping tool to the current gold standard, which is (intraoperative) direct cortical stimulation (DCS) mapping. A search in the databases of PubMed, EMBASE, and Web of Science was performed. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and recommendations were used. Thirty-five publications were included in the review, describing a total of 552 patients. All studies concerned either mapping of motor or language function. No comparative data for nTMS and DCS for other neurological functions were found. For motor mapping, the distances between the cortical representation of the different muscle groups identified by nTMS and DCS varied between 2 and 16 mm. Regarding mapping of language function, solely an object naming task was performed in the comparative studies on nTMS and DCS. Sensitivity and specificity ranged from 10 to 100% and 13.3–98%, respectively, when nTMS language mapping was compared with DCS mapping. The positive predictive value (PPV) and negative predictive value (NPV) ranged from 17 to 75% and 57–100% respectively. The available evidence for nTMS as a mapping modality for motor and language function is discussed.

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Multimodal Surgical Treatment of High-Grade Gliomas in the Motor Area: The Impact of the Combination of Navigated Transcranial Magnetic Stimulation and Fluorescein-Guided Resection

Cited by 30 publications

References 68 publications

Assessing the Capabilities of Transcranial Magnetic Stimulation (TMS) to Aid in the Removal of Brain Tumors Affecting the Motor Cortex: A Systematic Review

Assessing the Capabilities of Transcranial Magnetic Stimulation (TMS) to Aid in the Removal of Brain Tumors Affecting the Motor Cortex: A Systematic Review

Mapping of Motor Function with Neuronavigated Transcranial Magnetic Stimulation: A Review on Clinical Application in Brain Tumors and Methods for Ensuring Feasible Accuracy

Comparing navigated transcranial magnetic stimulation mapping and “gold standard” direct cortical stimulation mapping in neurosurgery: a systematic review

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