A review of monopolar motor mapping and a comprehensive guide to continuous dynamic motor mapping for resection of motor eloquent brain tumors

Object The aim of this study was to compare quantitatively the methods of preoperative magnetic source (MS) imaging and intraoperative electrophysiological cortical mapping (ECM) in the localization of sensorimotor cortex in patients with intraaxial brain tumors. Methods Preoperative magnetoencephalography (MEG) was performed while patients received painless tactile somatosensory stimulation of the lip, hand, and foot. The early somatosensory evoked field was modeled using a single equivalent current dipole approach to estimate the spatial source of the response. Three-dimensional magnetic resonance image volume data sets with fiducials were coregistered with the MEG recordings to form the MS image. These individualized functional brain maps were integrated into a neuronavigation system. Intraoperative mapping of somatosensory and/or motor cortex was performed and sites were compared. In two subgroups of patients we compared intraoperative somatosensory and motor stimulation sites with MS imaging–based somatosensory localizations. Mediolateral projection of the MS imaging source localizations to the cortical surface reduced systematic intermodality discrepancies. The distance between two corresponding points determined using MS imaging and ECM was 12.5 ± 1.3 mm for somatosensory–somatosensory and 19 ± 1.3 mm for somatosensory–motor comparisons. The observed 6.5 mm increase in site separation was systematically demonstrated in the anteroposterior direction, as expected from actual anatomy. In fact, intraoperative sites at which stimulation evoked the same patient response exhibited a spatial variation of 10.7 ± 0.7 mm. Conclusions Preoperative MS imaging and intraoperative ECM show a favorable degree of quantitative correlation. Thus, MS imaging can be considered a valuable and accurate planning adjunct in the treatment of patients with intraaxial brain tumors.

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P166: Continuous dynamic mapping of the corticospinal tract during surgery of motor eloquent brain tumors

Clinical Neurophysiology ◽

10.1016/s1388-2457(14)50304-5 ◽

2014 ◽

Vol 125 ◽

pp. S90-S91

Author(s):

K. Seidel ◽

J. Beck ◽

P. Schucht ◽

A. Raabe

Keyword(s):

Brain Tumors ◽

Corticospinal Tract ◽

Dynamic Mapping ◽

Continuous Dynamic

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149 Continuous Dynamic Mapping of the Corticospinal Tract During Surgery of Motor Eloquent Brain Tumors

Neurosurgery ◽

10.1227/01.neu.0000432740.79451.f9 ◽

2013 ◽

Vol 60 ◽

pp. 169

Author(s):

Andreas Raabe ◽

Jürgen Beck ◽

Philippe Schucht ◽

Kathleen Seidel

Keyword(s):

Brain Tumors ◽

Corticospinal Tract ◽

Dynamic Mapping ◽

Continuous Dynamic

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Quantifying accuracy and precision of diffusion MR tractography of the corticospinal tract in brain tumors

Journal of Neurosurgery ◽

10.3171/2014.4.jns131160 ◽

2014 ◽

Vol 121 (2) ◽

pp. 349-358 ◽

Cited By ~ 51

Author(s):

Maria Luisa Mandelli ◽

Mitchel S. Berger ◽

Monica Bucci ◽

Jeffrey I. Berman ◽

Bagrat Amirbekian ◽

...

Keyword(s):

Brain Tumors ◽

Corticospinal Tract ◽

Diffusion Tensor ◽

Fiber Tracking ◽

Subcortical White Matter ◽

Motor Pathways ◽

Motor Mapping ◽

Fiber Tracts ◽

Accuracy And Precision ◽

Dti Fiber Tracking

Object The aim of this paper was to validate the diffusion tensor imaging (DTI) model for delineation of the corticospinal tract using cortical and subcortical white matter electrical stimulation for the location of functional motor pathways. Methods The authors compare probabilistic versus deterministic DTI fiber tracking by reconstructing the pyramidal fiber tracts on preoperatively acquired DTI in patients with brain tumors. They determined the accuracy and precision of these 2 methods using subcortical stimulation points and the sensitivity using cortical stimulation points. The authors further explored the reliability of these methods by estimation of the potential that the found connections were due to a random chance using a novel neighborhood permutation method. Results The probabilistic tracking method delineated tracts that were significantly closer to the stimulation points and was more sensitive than deterministic DTI fiber tracking to define the tracts directed to the motor sites. However, both techniques demonstrated poor sensitivity to finding lateral motor regions. Conclusions This study highlights the importance of the validation and quantification of preoperative fiber tracking with the aid of electrophysiological data during the surgery. The poor sensitivity of DTI to delineate lateral motor pathways reported herein suggests that DTI fiber tracking must be used with caution and only as adjunctive data to established methods for motor mapping.

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Efficacy of mechanical prophylaxis for venous thromboembolism in patients with brain tumors

Neurosurgical FOCUS ◽

10.3171/foc.2004.17.4.3 ◽

2004 ◽

Vol 17 (4) ◽

pp. 1-5 ◽

Cited By ~ 16

Author(s):

Kurtis I. Auguste ◽

Alfredo Quiñones-Hinojosa ◽

Mitchel S. Berger

Keyword(s):

Brain Tumors ◽

Anticoagulation Therapy ◽

Venous Stasis ◽

Mechanical Compression ◽

Compression Stockings ◽

Mechanical Prophylaxis ◽

Motor Mapping ◽

Compression Device ◽

Pneumatic Compression Device ◽

External Pneumatic Compression

Patients with brain tumors are at considerable risk for the formation of venous thromboemboli. One method of preventing these complications is mechanical prophylaxis in which an external pneumatic compression device and graduated elastic compression stockings are used. Evidence indicates that these devices prevent deep venous thrombosis (DVT) and pulmonary embolism (PE) by limiting venous stasis and increasing fibrinolytic activity at both the local and systemic levels. The authors present evidence for the occurrence of both mechanisms and discuss the use of mechanical compression in the setting of surgery for brain tumors. They also present data proving the efficacy of these devices in patients who undergo craniotomy with motor mapping for resection of glioma and in whom the contralateral leg receives no prophylaxis. Finally, they comment on the use of anticoagulation therapy both in addition to and in place of mechanical prophylaxis.

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Navigated Transcranial Magnetic Stimulation Motor Mapping Usefulness in the Surgical Management of Patients Affected by Brain Tumors in Eloquent Areas: A Systematic Review and Meta-Analysis

Frontiers in Neurology ◽

10.3389/fneur.2021.644198 ◽

2021 ◽

Vol 12 ◽

Author(s):

Giuseppe Emmanuele Umana ◽

Gianluca Scalia ◽

Francesca Graziano ◽

Rosario Maugeri ◽

Nicola Alberio ◽

...

Keyword(s):

Systematic Review ◽

Transcranial Magnetic Stimulation ◽

Brain Tumors ◽

Brain Mapping ◽

Magnetic Stimulation ◽

Neurophysiological Monitoring ◽

Invasive Technique ◽

Navigated Transcranial Magnetic Stimulation ◽

Motor Mapping ◽

Mesh Terms

Background: The surgical strategy for brain glioma has changed, shifting from tumor debulking to a more careful tumor dissection with the aim of a gross-total resection, extended beyond the contrast-enhancement MRI, including the hyperintensity on FLAIR MR images and defined as supratotal resection. It is possible to pursue this goal thanks to the refinement of several technological tools for pre and intraoperative planning including intraoperative neurophysiological monitoring (IONM), cortico-subcortical mapping, functional MRI (fMRI), navigated transcranial magnetic stimulation (nTMS), intraoperative CT or MRI (iCT, iMR), and intraoperative contrast-enhanced ultrasound. This systematic review provides an overview of the state of the art techniques in the application of nTMS and nTMS-based DTI-FT during brain tumor surgery.Materials and Methods: A systematic literature review was performed according to the PRISMA statement. The authors searched the PubMed and Scopus databases until July 2020 for published articles with the following Mesh terms: (Brain surgery OR surgery OR craniotomy) AND (brain mapping OR functional planning) AND (TMS OR transcranial magnetic stimulation OR rTMS OR repetitive transcranial stimulation). We only included studies regarding motor mapping in craniotomy for brain tumors, which reported data about CTS sparing.Results: A total of 335 published studies were identified through the PubMed and Scopus databases. After a detailed examination of these studies, 325 were excluded from our review because of a lack of data object in this search. TMS reported an accuracy range of 0.4–14.8 mm between the APB hotspot (n1/4 8) in nTMS and DES from the DES spot; nTMS influenced the surgical indications in 34.3–68.5%.Conclusion: We found that nTMS can be defined as a safe and non-invasive technique and in association with DES, fMRI, and IONM, improves brain mapping and the extent of resection favoring a better postoperative outcome.

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Multimodal navigation in the functional microsurgical resection of intrinsic brain tumors located in eloquent motor areas: role of tractography

Neurosurgical FOCUS ◽

10.3171/2009.11.focus09234 ◽

2010 ◽

Vol 28 (2) ◽

pp. E5 ◽

Cited By ~ 57

Author(s):

José M. González-Darder ◽

Pablo González-López ◽

Fernando Talamantes ◽

Vicent Quilis ◽

Victoria Cortés ◽

...

Keyword(s):

Brain Tumors ◽

Functional Data ◽

Motor Response ◽

Diffusion Tensor ◽

Neurological Deficits ◽

Motor Mapping ◽

Wave Inversion ◽

The Mean ◽

Motor Areas

Object Nowadays the role of microsurgical management of intrinsic brain tumors is to maximize the volumetric resection of the tumoral tissue, minimizing the postoperative morbidity. The purpose of this paper was to study the benefits of an original protocol developed for the microsurgical treatment of tumors located in eloquent motor areas where the navigation and electrical stimulation of motor subcortical pathways have been implemented. Methods A total of 17 patients who underwent resection of cortical or subcortical tumors in motor areas have been included in the series. The preoperative planning for multimodal navigation was done by integrating anatomical studies, motor functional MR (fMR) imaging, and subcortical pathway volumes generated by diffusion tensor (DT) imaging. Intraoperative neuromonitoring included motor mapping by direct cortical stimulation (CS) and subcortical stimulation (sCS), and localization of the central sulcus by using cortical multipolar electrodes and the N20 wave inversion technique. The location of all cortically and subcortically stimulated points with positive motor response was stored in the navigator and correlated with the cortical and subcortical motor functional structures defined preoperatively. Results The mean tumoral volumetric resection was 89.1 ± 14.2% of the preoperative volume, with a total resection (≥ 100%) in 8 patients. Preoperatively a total of 58.8% of the patients had some kind of motor neurological deficit, increasing 24 hours after surgery to 70.6% and decreasing to 47.1% at 1 month later. There was a great correlation between anatomical and functional data, both cortically and subcortically. A total of 52 cortical points submitted to CS had positive motor response, with a positive correlation of 83.7%. Also, a total of 55 subcortical points had positive motor response; in these cases the mean distance from the stimulated point to the subcortical tract was 7.3 ± 3.1 mm. Conclusions The integration of anatomical and functional studies allows a safe functional resection of the brain tumors located in eloquent areas. Multimodal navigation allows integration and correlation among preoperative and intraoperative anatomical and functional data. Cortical motor functional areas are anatomically and functionally located preoperatively thanks to MR and fMR imaging and subcortical motor pathways with DT imaging and tractography. Intraoperative confirmation is done with CS and N20 inversion wave for cortical structures and with sCS for subcortical pathways. With this protocol the authors achieved a good volumetric resection in cortical and subcortical tumors located in eloquent motor areas, with an increase in the incidence of neurological deficits in the immediate postoperative period that significantly decreased 1 month later. Ongoing studies must define the safe limits for functional resection, taking into account the intraoperative brain shift. Finally, it must be demonstrated whether this protocol has any long-term benefit for patients by prolonging the disease-free interval, the time to recurrence, or the survival time.

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