Safety and tolerability of navigated TMS for preoperative mapping in neurosurgical patients

Tarapore, Phiroz E.; Picht, Thomas; Bulubas, Lucia; Shin, Yasushi; Kulchytska, Natalia; Meyer, Bernhard; Berger, Mitchel S.; Nagarajan, Srikantan S.; Krieg, Sandro M.

doi:10.1016/j.clinph.2015.11.042

Cited by 92 publications

(57 citation statements)

References 29 publications

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“…This fact confirms the safety data on single pulse nTMS in general (Anand and Hotson, 2002, Tassinari et al, 2003, Rossi et al, 2009, Tarapore et al, 2016a) and particularly in brain tumour patients (Tarapore et al, 2016b). However, transient headache (< 24 h) occurred in 6% of the patients ( N = 2/32) following nTMS, as expected from previous studies which described this phenomenon as the most frequent side effect associated with TMS (6–60% for repetitive TMS) (Machii et al, 2006).…”

Section: Discussionsupporting

confidence: 87%

“…By contrast, patients were excluded in case of severe renal failure (glomerular filtration rate < 30 ml/min) due to contraindication with respect to the administration of gadolinium-contrast agent or if they suffered from uncontrolled epilepsy (generalized seizure within 48 h prior to nTMS, insufficient dosage of anticonvulsive drugs in case of previous seizures). Please note that like in other single pulse nTMS studies with brain tumour patients (Tarapore et al, 2016b), epilepsy was not considered as a general exclusion criteria as long as all patients were under effective anticonvulsive treatment. Since the risk of inducing a seizure was considered very low in the given patient selection, it was clearly outweighed by the benefit of gathering information about eloquent cortex in order to prevent operation-induced motor disability.…”

Section: Methodsmentioning

confidence: 99%

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Functional MRI vs. navigated TMS to optimize M1 seed volume delineation for DTI tractography. A prospective study in patients with brain tumours adjacent to the corticospinal tract

Lucas

Tursunova

Neuschmelting

et al. 2017

NeuroImage: Clinical

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BackgroundDTI-based tractography is an increasingly important tool for planning brain surgery in patients suffering from brain tumours. However, there is an ongoing debate which tracking approaches yield the most valid results. Especially the use of functional localizer data such as navigated transcranial magnetic stimulation (nTMS) or functional magnetic resonance imaging (fMRI) seem to improve fibre tracking data in conditions where anatomical landmarks are less informative due to tumour-induced distortions of the gyral anatomy. We here compared which of the two localizer techniques yields more plausible results with respect to mapping different functional portions of the corticospinal tract (CST) in brain tumour patients.MethodsThe CSTs of 18 patients with intracranial tumours in the vicinity of the primary motor area (M1) were investigated by means of deterministic DTI. The core zone of the tumour-adjacent hand, foot and/or tongue M1 representation served as cortical regions of interest (ROIs). M1 core zones were defined by both the nTMS hot-spots and the fMRI local activation maxima. In addition, for all patients, a subcortical ROI at the level of the inferior anterior pons was implemented into the tracking algorithm in order to improve the anatomical specificity of CST reconstructions. As intra-individual control, we additionally tracked the CST of the hand motor region of the unaffected, i.e., non-lesional hemisphere, again comparing fMRI and nTMS M1 seeds. The plausibility of the fMRI-ROI- vs. nTMS-ROI-based fibre trajectories was assessed by a-priori defined anatomical criteria. Moreover, the anatomical relationship of different fibre courses was compared regarding their distribution in the anterior-posterior direction as well as their location within the posterior limb of the internal capsule (PLIC).ResultsOverall, higher plausibility rates were observed for the use of nTMS- as compared to fMRI-defined cortical ROIs (p < 0.05) in tumour vicinity. On the non-lesional hemisphere, however, equally good plausibility rates (100%) were observed for both localizer techniques. fMRI-originated fibres generally followed a more posterior course relative to the nTMS-based tracts (p < 0.01) in both the lesional and non-lesional hemisphere.ConclusionNTMS achieved better tracking results than fMRI in conditions when the cortical tract origin (M1) was located in close vicinity to a brain tumour, probably influencing neurovascular coupling. Hence, especially in situations with altered BOLD signal physiology, nTMS seems to be the method of choice in order to identify seed regions for CST mapping in patients.

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Section: Discussionsupporting

confidence: 87%

Section: Methodsmentioning

confidence: 99%

Functional MRI vs. navigated TMS to optimize M1 seed volume delineation for DTI tractography. A prospective study in patients with brain tumours adjacent to the corticospinal tract

Lucas

Tursunova

Neuschmelting

et al. 2017

NeuroImage: Clinical

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“…Surgical decision making has to balance extent of surgical resection and preservation of motor function. Preoperative nTMS is a safe and well tolerated method in the preoperative workup for neurosurgical patients (Tarapore et al, ). The present study affirmed these findings.…”

Section: Discussionmentioning

confidence: 99%

Preoperative navigated transcranial magnetic stimulation in patients with motor eloquent lesions with emphasis on metastasis

et al. 2016

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Navigated transcranial magnetic stimulation (nTMS) is a frequently used, non-invasive method to map the motor cortex. It is of great value in the preoperative workup of patients that suffer from motor eloquent brain lesions. Here, we present a single-center experience using preoperative nTMS in cortical motor eloquent lesions with emphasis on metastasis. All patients that underwent preoperative nTMS between June 2013 and January 2016 were evaluated. A total of 61 patients underwent nTMS before undergoing surgery for a motor eloquent brain lesion. Patients suffered from cerebral metastasis (23), glioblastoma (16), high grade glioma WHO III (4), low grade glioma WHO II (4), lymphoma (2), meningioma (8), cavernous hemangioma (3), or arteriovenous malformation (1). Thirty patients (49.2%) presented with a preoperative motor deficit. One week after surgery, paresis had resolved or improved in 56.7% of the patients. Out of the patients with postoperative paresis, 89.5% experienced an improvement of motor status at follow-up. All metastatic lesions were completely resected compared to 78.9% of non-metastatic lesions (P = 0.02). Only 4.3% of patients with a metastatic lesion, but 26.3% of patients with a non-metastatic lesion experienced deterioration of motor function after surgery (P = 0.04). Preoperative nTMS is suitable for mapping of a variety of motor eloquent brain lesions resulting in favorable neurological outcome. Particularly in metastatic motor eloquent lesion, motor function appears to be preserved after surgery. Clin. Anat. 29:925-931, 2016. © 2016 Wiley Periodicals, Inc.

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“…Navigated transcranial magnetic stimulation (nTMS) is a non-invasive technique increasingly used for pre-surgical motor and language/speech mapping in patients with brain lesions [1,2]. Repetitive navigated transcranial magnetic stimulation (rTMS) is increasingly used for language mapping in combination with functional magnetic resonance imaging (fMRI) for preoperative mapping of patients undergoing neurosurgical operation [3].…”

Section: Introductionmentioning

confidence: 99%

Preoperative Mapping of Primary Motor and Broca’s Area with Transcranial Magnetic Stimulation (TMS) – Case Report

Vidaković¹,

Vujović²

2017

J Neurol Exp Neurosci

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Safety and tolerability of navigated TMS for preoperative mapping in neurosurgical patients

Cited by 92 publications

References 29 publications

Functional MRI vs. navigated TMS to optimize M1 seed volume delineation for DTI tractography. A prospective study in patients with brain tumours adjacent to the corticospinal tract

Functional MRI vs. navigated TMS to optimize M1 seed volume delineation for DTI tractography. A prospective study in patients with brain tumours adjacent to the corticospinal tract

Preoperative navigated transcranial magnetic stimulation in patients with motor eloquent lesions with emphasis on metastasis

Preoperative Mapping of Primary Motor and Broca’s Area with Transcranial Magnetic Stimulation (TMS) – Case Report

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