Preoperative motor mapping by navigated transcranial magnetic brain stimulation improves outcome for motor eloquent lesions

Krieg, Sandro M.; Sabih, Jamil; Bulubas, Lucia; Obermueller, Thomas; Negwer, Chiara; Janssen, Insa; Shiban, Ehab; Meyer, Bernhard; Ringel, Florian

doi:10.1093/neuonc/nou007

Cited by 131 publications

(103 citation statements)

References 31 publications

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“…Performing surgery on eloquent gliomas (located in motor-eloquent or language-eloquent brain areas) is still a challenging quest to balance gross total resection (GTR) and preservation of motor and language function, which is indispensable for individuals' quality of life. To achieve this goal, various pre-and intraoperative modalities are nowadays used: preoperative functional neuroimaging and navigated transcranial magnetic stimulation (nTMS) are helpful methods to reveal the relation of the tumor to eloquent areas, especially for surgical planning, and have recently been shown to improve the extent of resection and to reduce deficit rates (Krieg et al 2014a;Frey et al 2014). Thus, although intraoperative stimulation mapping, i.e., direct cortical stimulation (DCS), represents the gold standard to localize motor and language function, these new data motivate researchers to investigate the potential for further refinement of preoperative planning (Haglund et al 1994;G.…”

Section: Introductionmentioning

confidence: 99%

Visualization of subcortical language pathways by diffusion tensor imaging fiber tracking based on rTMS language mapping

Negwer

Ille

Hauck

et al. 2016

Brain Imaging and Behavior

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Diffusion tensor imaging fiber tracking (DTI FT) is used to visualize subcortical fiber tracts. Yet, there is no standard at hand to visualize language-involved subcortical fibers reliably. Thus, this study investigates the feasibility of using language-related cortical areas identified via repetitive navigated transcranial magnetic stimulation (rTMS) to seed DTI FT of subcortical language tracts. From 2011 to 2014, 37 patients with left-hemispheric perisylvian lesions were examined. Language-positive rTMS stimulation spots were integrated in the deterministic tractography software (BrainLAB, iPlanNet 3.0) as objects and used as seed regions for DTI FT. Tractography was then performed in each patient with 77 different combinations of fiber lengths (40 - 100 mm) and fractional anisotropy (FA; 0.01 - 0.5). The rTMS-based DTI FT identified all commonly known subcortical language tracts, such as the corticonuclear tract, arcuate fascicle, uncinate fascicle, superior longitudinal fascicle, inferior longitudinal fascicle, arcuate fibers, commissural fibers, corticothalamic fibers, and the fronto-occipital fascicle. In 32 patients (86.5 %), each above-named tract could be visualized, while at least 6 out of these 9 tracts were identified in each patient. A fiber length of 100 mm and an FA of 0.1 or 0.15 provided optimal visualization by revealing 125 and 61 individually tracked fibers per visualized language tract and 90 % and 73 % of all language-related tracts, respectively. This study proves the feasibility of rTMS-based DTI FT for subcortical language tracts, provides suitable settings, and shows its easy and standardizable application for the visualization of every language tract in 86.5 % of patients.

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Section: Introductionmentioning

confidence: 99%

Visualization of subcortical language pathways by diffusion tensor imaging fiber tracking based on rTMS language mapping

Negwer

Ille

Hauck

et al. 2016

Brain Imaging and Behavior

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“…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.…”

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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

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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...

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“…19, [35][36][37][38] Other authors have used fMRI as the template to guide confirmatory intraoperative mapping 2,9-11,17,39; however, this was not feasible in this retrospective study. Because fMRI postprocessing is a computationally intensive process, results on the success of a paradigm are not known until after the anesthesia-based procedure is complete, which prevents the duplication of paradigms with spurious results or without appreciable cortical activation.…”

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confidence: 91%

Cortical Activation Through Passive-Motion Functional MRI

Choudhri

Patel

Siddiqui

et al. 2015

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE: Functional brain mapping is an important technique for neurosurgical planning, particularly for patients with tumors or epilepsy; however, mapping has traditionally involved invasive techniques. Existing noninvasive techniques require patient compliance and may not be suitable for young children. We performed a retrospective review of our experience with passive-motion functional MR imaging in anesthetized patients to determine the diagnostic yield of this technique.

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Preoperative motor mapping by navigated transcranial magnetic brain stimulation improves outcome for motor eloquent lesions

Cited by 131 publications

References 31 publications

Visualization of subcortical language pathways by diffusion tensor imaging fiber tracking based on rTMS language mapping

Visualization of subcortical language pathways by diffusion tensor imaging fiber tracking based on rTMS language mapping

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

Cortical Activation Through Passive-Motion Functional MRI

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