Preoperative Functional Mapping for Rolandic Brain Tumor Surgery: Comparison of Navigated Transcranial Magnetic Stimulation to Direct Cortical Stimulation

Picht, Thomas; Schmidt, Sein; Brandt, Stephan A.; Frey, Dietmar; Hannula, Henri; Neuvonen, Tuomas; Karhu, Jari; Vajkoczy, Peter; Suess, Olaf

doi:10.1227/neu.0b013e3182181b89

Cited by 244 publications

(166 citation statements)

References 14 publications

Supporting

Mentioning

152

Contrasting

Unclassified

Order By: Relevance

“…Good correlation of preoperative nTMS and intraoperative DCS motor maps has been repeatedly reported. [12][13][14][15] In addition, repetitive transcranial magnetic stimulation (rTMS) has been used for disturbing speech and determination of language lateralization. [16][17][18][19][20] By using the combination of TMS and a navigation system, it is possible to specifically identify the cortical regions vulnerable to rTMS, which are presumably speech eloquent.…”

mentioning

confidence: 99%

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

et al. 2013

Self Cite

View full text Add to dashboard Cite

BACKGROUND: 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. Repetitive nTMS can also be used for mapping of speech-sensitive cortical areas. OBJECTIVE: The current cohort study compares the safety and effectiveness of preoperative nTMS with DCS mapping during awake surgery for the identification of language areas in patients with left-sided cerebral lesions. METHODS: Twenty patients with tumors in or close to left-sided language eloquent regions were examined by repetitive nTMS before surgery. During awake surgery, language-eloquent cortex was identified by DCS. nTMS results were compared for accuracy and reliability with regard to DCS by projecting both results into the cortical parcellation system. RESULTS: Presurgical nTMS maps showed an overall sensitivity of 90.2%, specificity of 23.8%, positive predictive value of 35.6%, and negative predictive value of 83.9% compared with DCS. For the anatomic Broca's area, the corresponding values were a sensitivity of 100%, specificity of 13.0%, positive predictive value of 56.5%, and negative predictive value of 100%, respectively. CONCLUSION: Good overall correlation between repetitive nTMS and DCS was observed, particularly with regard to negatively mapped regions. Noninvasive inhibition mapping with nTMS is evolving as a valuable tool for preoperative mapping of language areas. Yet its low specificity in posterior language areas in the current study necessitates further research to refine the methodology.

show abstract

mentioning

confidence: 99%

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

et al. 2013

Self Cite

View full text Add to dashboard Cite

show abstract

“…Regarding the mapping of motor function, nTMS has already demonstrated its usefulness for clinical practice. 22,33,35,52,53,77 Furthermore, repetitive navigated TMS (rTMS) and nonnavigated TMS are able to localize cortical language function. 18,19,40,48,69,80 Its clinical applicability and correlation to DCS during awake surgery have repeatedly been shown as well.…”

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

100

View full text Add to dashboard Cite

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...

show abstract

“…Multiple types of functional brain mapping have been reported (mostly applied in tumor surgery), and several advantages specific to each mapping type have been described. 2,5,6,8,12,13,[21][22][23]27,28 Regardless of the suggested benefits of other mapping methods, TMS offers the advantage of being the only noninvasive, reversible inhibition technique and is more commonly used in the neurosurgical field for motor mapping in patients incapable of fully cooperating. 13,28 Transcranial magnetic stimulation results on lateralization of motor innervation were confirmed using fMRI in a recent study.…”

Section: Discussionmentioning

confidence: 99%

“…28 A noninvasive instrument that is increasingly used in tumor surgery is transcranial magnetic stimulation (TMS). It can stimulate the cortex by generating a magnetic field passing through the scalp [21][22][23]28 and may be used to map the motor cortex by activating the cortex with single pulses and to simultaneously record motor evoked potentials. 18,28 Transcranial magnetic stimulation has the advanSurgery for a giant arteriovenous malformation without motor deterioration: preoperative transcranial magnetic stimulation in a non-cooperative patient Case Transcranial magnetic stimulation (TMS) is a noninvasive activation method that is increasingly used for motor mapping.…”

mentioning

confidence: 99%

Surgery for a giant arteriovenous malformation without motor deterioration: preoperative transcranial magnetic stimulation in a non-cooperative patient

Kronenburg¹,

Doormaal²,

Eijsden³

et al. 2014

PED

View full text Add to dashboard Cite

Transcranial magnetic stimulation (TMS) is a noninvasive activation method that is increasingly used for motor mapping. Preoperative functional mapping in vascular surgery is not routinely performed; however, in cases of high-grade arteriovenous malformations (AVMs), it could play a role in preoperative decision making. A 16-year-old male was suffering from a giant, right-sided insular, Spetzler-Martin Grade V AVM. This patient's history included 3 hemorrhagic strokes in the past 3 years, resulting in Medical Research Council Grade 2–3 (proximal) and 2–4 (distal) paresis of the left side of the body and hydrocephalus requiring a ventriculoperitoneal shunt. Preoperative TMS showed absent contralateral innervation of the remaining left-sided motor functions. Subsequently, the AVM was completely resected without any postoperative increase of the left-sided paresis. This case shows that TMS can support decision making in AVM treatment by mapping motor functions.

show abstract

Preoperative Functional Mapping for Rolandic Brain Tumor Surgery: Comparison of Navigated Transcranial Magnetic Stimulation to Direct Cortical Stimulation

Abstract: Peritumoral mapping of the motor cortex by nTMS agreed well with the gold standard of DCS. Thus, nTMS is a reliable tool for preoperative mapping of motor function.

Cited by 244 publications

References 14 publications

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

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

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

Surgery for a giant arteriovenous malformation without motor deterioration: preoperative transcranial magnetic stimulation in a non-cooperative patient

Contact Info

Product

Resources

About