The impact of nTMS mapping on treatment of brain AVMs

Ille, Sebastian; Picht, Thomas; Shiban, Ehab; Meyer, Bernhard; Vajkoczy, Peter; Krieg, Sandro M.

doi:10.1007/s00701-018-3475-2

Cited by 15 publications

(11 citation statements)

References 39 publications

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“…Ille et al (17) published similar findings to Germanò et al (16) showing that nTMS mapping resulted in modified SM grading of AVMs. By combining nTMS and nTMS-based DTI-FT, white matter tracts and motor and speech networks were visualized in a total of 34 patients.…”

Section: Transcranial Magnetic Stimulationsupporting

confidence: 55%

“…Among these studies, a total of 77 (32.5%) patients experienced cortical reorganization. In two series, SM grading was reported to be directly impacted by the findings of cortical mapping studies (16,17), with at least half of the studies suggesting preoperative mapping to be useful in identifying eloquent tissue that is otherwise anatomically distorted or unidentifiable on MR imaging. SM grading was downgraded in most cases, as functional eloquence was found to be away from the AVM nidus, favoring surgical resection.…”

Section: Discussionmentioning

confidence: 99%

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Systematic Review of Functional Mapping and Cortical Reorganization in the Setting of Arteriovenous Malformations, Redefining Anatomical Eloquence

et al. 2020

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The goal of this study was to systematically review functional mapping and reorganization that takes place in the setting of arteriovenous malformations (AVMs) and its potential impact on grading and surgical decision making. Methods: A systematic literature review was performed using the PubMed database for studies published between 1986 and 2019. Studies assessing brain mapping and functional reorganization in AVMs were included. Results: Of the total 84 articles identified in the original literature search, 12 studies were ultimately selected. This includes studies evaluating the impact of cortical reorganization on patient outcomes and factors impacting and triggering cortical reorganization in AVM. Conclusion: These studies demonstrate the utility of preoperative brain mapping and acknowledgment of functional reorganization in the setting of AVMs. While these findings led to alterations in Spetzler-Martin grading and subsequent surgical decision making, it remains unclear the clinical utility of this information when assessing patient outcomes. While promising, more research is required before recommendations can be made regarding functional brain mapping and cortical reorganization with respect to AVM surgery involving eloquent brain tissue.

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Section: Transcranial Magnetic Stimulationsupporting

confidence: 55%

Section: Discussionmentioning

confidence: 99%

Systematic Review of Functional Mapping and Cortical Reorganization in the Setting of Arteriovenous Malformations, Redefining Anatomical Eloquence

et al. 2020

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“…Over the last decade, nTMS has been used by neurosurgeons to map functional areas of the brain for surgical planning in neuro-oncology [5,22], AVM resection [7,9,16], and epilepsy [13]. A successful nTMS depends largely on patient cooperation, with a long duration of the exam and fatigue or discomfort potentially affecting the results of the mapping.…”

Section: Discussionmentioning

confidence: 99%

“…Navigated transcranial magnetic stimulation (nTMS) has become in recent years a commonly used tool in the preoperative planning for neurosurgical patients [8]. nTMS is now being widely used as an important pre-operative tool for motor and speech mapping in eloquent glioma surgery (awake/asleep), brain metastasis, cavernoma, and vascular malformations [5,7,14,15,17,20,23,25] and is a useful adjunct to impact the surgical indications, guide the surgical approach, and estimate and reduce the risk of inducing postsurgical deficits [26,27]. It has further been highlighted in recent studies that the preoperative nTMS motor mapping/ speech mapping provides improved outcome in patients with glioblastoma [24] and is also useful in language-eloquent tumour surgery in awake-ineligible patients [25].…”

Section: Introductionmentioning

confidence: 99%

Patient-reported experience measures in patients undergoing navigated transcranial magnetic stimulation (nTMS): the introduction of nTMS-PREMs

et al. 2020

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Background Patient-reported experience measures (PREMs) are a unique measure of experience of patients which can help address the quality of care of the patients. Objective Our aim of the study is to collect quality of care outcomes with our newly navigated transcranial magnetic stimulation patient-reported experience measure (nTMS-PREMs) questionnaire among neurosurgical patients undergoing nTMS. Methods A single-centre prospective nTMS-PREMs 19-item questionnaire study was performed between February 2018 and December 2018 on patient referred for nTMS at our hospital. The Data was analysed using Likert scale, linear and logistic regression using statistical software (STATA 13.0®). Results Fifty patient questionnaires were collected (30 males, 20 females, mean age of 47.6 ± 2.1 years) among which 74% of patients underwent both motor and language mapping with a mean duration of 103.3 ± 5.1 min. An overall positive response was noted from the results of the questionnaire, tiredness and anxiety being the common effects noted. Patients with the left-sided disease appreciated more the conditions provided in our laboratory (Q4, p = 0.040) and increasing age was related to less confidence and trust (Q6, p = 0.038) in the staff performing the exam. Younger patients tolerated nTMS better than older patients (> 65 years). PubMed literature search resulted in no relevant articles on the use of PREMs in nTMS patients. Conclusion nTMS is a well-tolerated non-invasive tool and nTMS-PREMS provides a promising role in identifying the unmet needs of the patients and improving the quality of their care.

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“…Some preliminary reports have demonstrated that nTMS motor and language mapping may be useful also for surgery of brain arteriovenous malformations 15,23,28 and of convexity meningiomas located in the central region. 55 Interestingly, a similar approach has been recently reported as effective also before epilepsy surgery.…”

Section: Future Perspectives and Applicationsmentioning

confidence: 99%

When imaging meets neurophysiology: the value of navigated transcranial magnetic stimulation for preoperative neurophysiological mapping prior to brain tumor surgery

Raffa

Quattropani

Germanò

2019

Neurosurgical Focus

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Maximal safe resection is the modern goal for surgery of intrinsic brain tumors located in or close to brain eloquent areas. Nowadays different neuroimaging techniques provide important anatomical and functional information regarding the brain functional organization that can be used to plan a customized surgical strategy to preserve functional networks, and to increase the extent of tumor resection. Among these techniques, navigated transcranial magnetic stimulation (nTMS) has recently gained great favor among the neurosurgical community for preoperative mapping and planning prior to brain tumor surgery. It represents an advanced neuroimaging technique based on the neurophysiological mapping of the functional cortical brain organization. Moreover, it can be combined with other neuroimaging techniques such as diffusion tensor imaging tractography, thus providing a reliable reconstruction of brain eloquent networks. Consequently, nTMS mapping may provide reliable noninvasive brain functional mapping, anticipating information that otherwise may be available to neurosurgeons only in the operating theater by using direct electrical stimulation. The authors describe the reliability and usefulness of the preoperative nTMS-based approach in neurosurgical practice, and briefly discuss their experience using nTMS as well as currently available evidence in the literature supporting its clinical use. In particular, special attention is reserved for the discussion of the role of nTMS as a novel tool for the preoperative neurophysiological mapping of motor and language networks prior to surgery of intrinsic brain tumors located in or close to eloquent networks, as well as for future and promising applications of nTMS in neurosurgical practice.

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The impact of nTMS mapping on treatment of brain AVMs

Abstract: In 21 of 34 cases (62%), nTMS was a supportive argument. We could show that nTMS motor and language data can be used for a more objective decision-making regarding the treatment of BAVMs and for a more detailed SM grading regarding the rating of eloquence.

Cited by 15 publications

References 39 publications

Systematic Review of Functional Mapping and Cortical Reorganization in the Setting of Arteriovenous Malformations, Redefining Anatomical Eloquence

Systematic Review of Functional Mapping and Cortical Reorganization in the Setting of Arteriovenous Malformations, Redefining Anatomical Eloquence

Patient-reported experience measures in patients undergoing navigated transcranial magnetic stimulation (nTMS): the introduction of nTMS-PREMs

When imaging meets neurophysiology: the value of navigated transcranial magnetic stimulation for preoperative neurophysiological mapping prior to brain tumor surgery

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