P07.02 Robot-assisted stereotactic brain biopsy combined with cortical mapping using navigated transcranial magnetic stimulation

2021 ◽  
Vol 23 (Supplement_2) ◽  
pp. ii25-ii25
Author(s):  
G E D Petrescu ◽  
R Radu ◽  
C Gorgan ◽  
A Giovani ◽  
F M Brehar ◽  
...  
Keyword(s):  
Transcranial Magnetic Stimulation ◽  
Magnetic Stimulation ◽  
Brain Biopsy ◽  
Robotic Arm ◽  
Cortical Mapping ◽  
Diffuse Astrocytoma ◽  
Navigated Transcranial Magnetic Stimulation ◽  
Stereotactic Brain Biopsy ◽  
Eloquent Areas ◽  
The Right

Abstract BACKGROUND Frame-based stereotactic biopsy has been for decades the gold-standard method for taking samples of brain tumors for the histopathological diagnostic in cases when surgery was contraindicated. However, novel frameless techniques have been developed in order to facilitate the procedure for the neurosurgeon, and for the patient as well. Preoperative cortical mapping techniques enable the planning of the trajectory with the sparing of eloquent areas. MATERIAL AND METHODS A preoperative cortical mapping using navigated transcranial magnetic stimulation was performed in the case of a 37-year-old male that presented with headache. The MRI scan revealed multiple lesions located frontal lobe and temporal lobe on the right hemisphere and frontal and occipital lobes on the left hemisphere. The results of the preoperative cortical mapping were integrated into the neuronavigation system and used for the planning of the frameless based stereotactic brain biopsy. A biopsy procedure was performed using a robotic arm according to the planned trajectory. RESULTS The targeted lesion was the right frontal one. The planned trajectory took into account the results from the cortical mapping using nTMS, and the eloquent areas were avoided. The robotic arm guided the procedure and aligned to the entry point and trajectory. According to the histopathological result the lesion was a grade II diffuse astrocytoma. There were no perioperative complications. CONCLUSION To our knowledge, this is the first report that describes the use of a robot-guided frameless brain biopsy system combined with the preoperative mapping of the eloquent cortical areas using navigated transcranial magnetic stimulation. This approach is a safe one and carries less burden for the patient as well as for the surgeon.

Stereotactic Brain Biopsy in Eloquent Areas Assisted by Navigated Transcranial Magnetic Stimulation: a Technical Case Report

2018 ◽  
Vol 17 (3) ◽  
pp. E124-E129 ◽  
Author(s):  
Jiri Bartek ◽  
Gerald Cooray ◽  
Mominul Islam ◽  
Margret Jensdottir
Keyword(s):  
Transcranial Magnetic Stimulation ◽  
Magnetic Stimulation ◽  
Stereotactic Biopsy ◽  
Brain Biopsy ◽  
Awake Surgery ◽  
Histopathological Diagnosis ◽  
Navigated Transcranial Magnetic Stimulation ◽  
Stereotactic Brain Biopsy ◽  
Eloquent Areas ◽  
The Brain

Abstract BACKGROUND AND IMPORTANCE Stereotactic brain biopsy (SB) is an important part of the neurosurgical armamentarium, with the possibility of achieving histopathological diagnosis in otherwise inaccessible lesions of the brain. Nevertheless, the procedure is not without the risk of morbidity, which is especially true for lesions in eloquent parts of the brain, where even a minor adverse event can result in significant deficits. Navigated transcranial magnetic stimulation (nTMS) is widely used to chart lesions in eloquent areas, successfully guiding maximal safe resection, while its potential role in aiding with the planning of a stereotactic biopsy is so far unexplored. CLINICAL PRESENTATION Magnetic resonance imaging of a 67-yr-old woman presenting with dysphasia revealed a noncontrast enhancing left-sided lesion in the frontal and parietal pars opercularis. Due to the location of the lesion, nTMS was used to chart both primary motor and language cortex, utilizing this information to plan a safe SB trajectory and sampling area according to the initial work-up recommendations from the multidisciplinary neuro-oncology board. The SB was uneventful, with histology revealing a ganglioglioma, WHO I. The patient was discharged the following day, having declined to proceed with tumor resection (awake surgery) due to the non-negligible risk of morbidity. Upon 1- and 3-mo follow-up, she showed no signs of any procedure-related deficits. CONCLUSION nTMS can be implemented to aid with the planning of a stereotactic biopsy procedure in eloquent areas of the brain, and should be considered part of the neurosurgical armamentarium.

scholarly journals Navigated transcranial magnetic stimulation mapping in patients with language-eloquent brain lesions

2021 ◽  
pp. 14-19
Author(s):  
George E. D. Petrescu ◽  
Roxana Radu ◽  
Andrei Giovani ◽  
Cristina Gorgan ◽  
Felix M. Brehar ◽  
...  
Keyword(s):  
Transcranial Magnetic Stimulation ◽  
Surgical Resection ◽  
Error Rate ◽  
Magnetic Stimulation ◽  
Brain Lesions ◽  
Cortical Mapping ◽  
Histopathological Diagnosis ◽  
Navigated Transcranial Magnetic Stimulation ◽  
Functional Deficits ◽  
Eloquent Areas

Introduction: The surgical resection of brain lesions located in language-eloquent areas harbours a great risk for determining new functional deficits. Navigated transcranial magnetic stimulation represents a novel non-invasive cortical mapping method that can be used preoperative to determine language-eloquent areas. Materials and methods: We retrospectively reviewed a prospectively maintained database of patients that underwent preoperative cortical mapping using nTMS between March 2017 and June 2020. Patients older than 18 years old with brain lesions situated in a presumed language eloquent area, that underwent surgical resection of the brain lesion were included in the study. Various parameters such as error rate, number of language-negative sites were assessed. Results: Fourteen patients were included in the study. There were 10 males and 4 females in total. Most of the tumours were in the temporal and frontal lobes (five and four cases, respectively). The histopathological diagnosis was glioblastoma in seven cases, in one case there was an anaplastic astrocytoma and there were two cases of low-grade gliomas. There were three cases of brain metastasis and one cavernoma. The median (range) tumor volume was 25.01 cm3 (0.89 – 86.55 cm3). Gross-total resection (GTR) was achieved in seven cases. The error rate was significantly higher in patients that continued to have an impaired language function after surgical resection (p = 0.016), while the perilesional error rate was higher in patients with preoperative aphasia (p = 0.019). Conclusion: Our findings suggest that a lower tumour volume to perilesional negative stimuli ratio is associated with an extended surgical resection of brain tumours located in language-eloquent areas and that patients that presented with aphasia and have a high error rate have a worse functional prognosis. Through nTMS preoperative cortical mapping of language-eloquent areas, the neurosurgeon has more insight regarding the cortical function and can maximize the surgical resection, while avoiding the onset of new functional deficits.

scholarly journals NIMG-02. CORTICAL PLASTICITY OF MOTOR-ELOQUENT AREAS MEASURED BY NAVIGATED TRANSCRANIAL MAGNETIC STIMULATION IN GLIOMA PATIENTS

2016 ◽  
Vol 18 (suppl_6) ◽  
pp. vi123-vi123
Author(s):  
Sandro M. Krieg ◽  
Sebastian Ille ◽  
Neal Conway ◽  
Noemi Wildschuetz ◽  
Lucia Bulubas ◽  
...  
Keyword(s):  
Transcranial Magnetic Stimulation ◽  
Magnetic Stimulation ◽  
Cortical Plasticity ◽  
Navigated Transcranial Magnetic Stimulation ◽  
Eloquent Areas

scholarly journals Preoperative Applications of Navigated Transcranial Magnetic Stimulation

2021 ◽  
Vol 11 ◽  
Author(s):  
Alexander F. Haddad ◽  
Jacob S. Young ◽  
Mitchel S. Berger ◽  
Phiroz E. Tarapore
Keyword(s):  
Transcranial Magnetic Stimulation ◽  
Magnetic Stimulation ◽  
Cortical Mapping ◽  
Navigated Transcranial Magnetic Stimulation ◽  
Patient Counseling ◽  
Language Mapping ◽  
Preoperative Mapping ◽  
Neurosurgical Patients ◽  
Cortical Regions ◽  
The Brain

Preoperative mapping of cortical structures prior to neurosurgical intervention can provide a roadmap of the brain with which neurosurgeons can navigate critical cortical structures. In patients undergoing surgery for brain tumors, preoperative mapping allows for improved operative planning, patient risk stratification, and personalized preoperative patient counseling. Navigated transcranial magnetic stimulation (nTMS) is one modality that allows for highly accurate, image-guided, non-invasive stimulation of the brain, thus allowing for differentiation between eloquent and non-eloquent cortical regions. Motor mapping is the best validated application of nTMS, yielding reliable maps with an accuracy similar to intraoperative cortical mapping. Language mapping is also commonly performed, although nTMS language maps are not as highly concordant with direct intraoperative cortical stimulation maps as nTMS motor maps. Additionally, nTMS has been used to localize cortical regions involved in other functions such as facial recognition, calculation, higher-order motor processing, and visuospatial orientation. In this review, we evaluate the growing literature on the applications of nTMS in the preoperative setting. First, we analyze the evidence in support of the most common clinical applications. Then we identify usages that show promise but require further validation. We also discuss developing nTMS techniques that are still in the experimental stage, such as the use of nTMS to enhance postoperative recovery. Finally, we highlight practical considerations when utilizing nTMS and, importantly, its safety profile in neurosurgical patients. In so doing, we aim to provide a comprehensive review of the role of nTMS in the neurosurgical management of a patient with a brain tumor.

scholarly journals Navigated transcranial magnetic stimulation of the supplementary motor cortex disrupts fine motor skills in healthy adults

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Severin Schramm ◽  
Lucia Albers ◽  
Sebastian Ille ◽  
Axel Schröder ◽  
Bernhard Meyer ◽  
...  
Keyword(s):  
Transcranial Magnetic Stimulation ◽  
Motor Skills ◽  
Magnetic Stimulation ◽  
Right Hemisphere ◽  
Fine Motor ◽  
Fine Motor Skills ◽  
Navigated Transcranial Magnetic Stimulation ◽  
Supplementary Motor Cortex ◽  
The Right ◽  
Stimulation Of

AbstractNavigated transcranial magnetic stimulation (nTMS) over the supplementary motor area (SMA) may impact fine motor skills. This study evaluates different nTMS parameters in their capacity to affect fine motor performance on the way to develop an SMA mapping protocol. Twenty healthy volunteers performed a variety of fine motor tests during baseline and nTMS to the SMA using 5 Hz, 10 Hz, and theta-burst stimulation (TBS). Effects on performance were measured by test completion times (TCTs), standard deviation of inter-tap interval (SDIT), and visible coordination problems (VCPs). The predominant stimulation effect was slowing of TCTs, i.e. a slowdown of test performances during stimulation. Furthermore, participants exhibited VCPs like accidental use of contralateral limbs or inability to coordinate movements. More instances of significant differences between baseline and stimulation occurred during stimulation of the right hemisphere compared to left-hemispheric stimulation. In conclusion, nTMS to the SMA could enable new approaches in neuroscience and enable structured mapping approaches. Specifically, this study supports interhemispheric differences in motor control as right-hemispheric stimulation resulted in clearer impairments. The application of our nTMS-based setup to assess the function of the SMA should be applied in patients with changed anatomo-functional representations as the next step, e.g. among patients with eloquent brain tumors.

scholarly journals Preoperative mapping of the eloquent cortical areas using navigated transcranial magnetic stimulation combined with intraoperative neuronavigation for intracerebral lesions

2018 ◽  
Vol 32 (1) ◽  
pp. 16-24
Author(s):  
G. Petrescu ◽  
Cristina Gorgan ◽  
A. Giovani ◽  
F.M. Brehar ◽  
R.M. Gorgan
Keyword(s):  
Transcranial Magnetic Stimulation ◽  
Surgical Resection ◽  
Magnetic Stimulation ◽  
Neurological Deficits ◽  
Navigated Transcranial Magnetic Stimulation ◽  
Mapping Procedure ◽  
Motor Mapping ◽  
Eloquent Areas ◽  
Preoperative Mapping ◽  
Eloquent Area

Abstract Introduction: Maximal surgical resection with the preservation of cortical functions is the treatment of choice for brain tumors. Achieving these objectives is especially difficult when the tumor is located in an eloquent area. Navigated transcranial magnetic stimulation (nTMS) is a modern non-invasive, preoperative method for defining motor and speech eloquent areas. Material and methods: Patients with tumors located in motor and speech eloquent areas who presented at our institution between March 2017 and December 2017 were prospectively included. Exclusion criteria were frequent generalized epileptic seizures and cranial implants. For lesions involving motor eloquent areas we performed a nTMS motor mapping and for lesions involving speech eloquent areas we supplemented the motor mapping with speech and language mapping. MR images were exported from the nTMS system in a DICOM format and then loaded in the intraoperative neuronavigation system. Based on these findings, the optimal entry point and trajectory were determined, in order to achieve a maximum surgical resection of the lesion, while avoiding new post-operative neurological deficits. Results: Nineteen patients underwent an nTMS brain mapping procedure between March 2017 and December 2017. In all cases a motor mapping procedure was done, but only in eight cases a speech mapping was also performed. Three patients presented new minor postoperatory deficits that consecutively remitted. The rest of the patients presented no added neurological deficits after surgery. In five cases the preexistent deficit was ameliorated after surgery and in three cases the deficit remitted. In one patient there was no improvement in the neurologic deficit after surgery. Conclusion: nTMS is a reliable tool for the preoperative planning of eloquent area lesions. It must be taken into account that functional areas have a high individual variability. Therefore, knowing preoperatively the extent of the eloquent area helps the neurosurgeon adapt the surgical approach in order to obtain a better functional outcome.

Navigated transcranial magnetic stimulation for preoperative language mapping in a patient with a left frontoopercular glioblastoma

2013 ◽  
Vol 118 (1) ◽  
pp. 175-179 ◽  
Author(s):  
Nico Sollmann ◽  
Thomas Picht ◽  
Jyrki P. Mäkelä ◽  
Bernhard Meyer ◽  
Florian Ringel ◽  
...  
Keyword(s):  
Transcranial Magnetic Stimulation ◽  
Magnetic Stimulation ◽  
Right Hemisphere ◽  
Inferior Frontal Gyrus ◽  
Awake Surgery ◽  
Navigated Transcranial Magnetic Stimulation ◽  
Clear Speech ◽  
Language Mapping ◽  
Motor Mapping ◽  
The Right

Up to now, navigated transcranial magnetic stimulation (nTMS) has been used for motor mapping in the vicinity of rolandic brain lesions. Recently, nTMS has also been suggested to be useful in mapping human language areas. The authors describe the case of a left-handed patient with a left-side glioblastoma within the opercular inferior frontal gyrus who presented with severe motor aphasia. Preoperative functional MRI (fMRI) indicated speech dominance of the right hemisphere and did not show any language-related activation in the vicinity of the tumor. Navigated TMS, however, showed a significantly higher rate of induced speech arrests for the left than for the right. Left-side direct cortical stimulation induced clear speech arrests during awake surgery. This case suggests that nTMS may be useful for preoperative speech mapping in tumors affecting the anatomy, vasculature, and brain oxygen levels and therefore impairing fMRI reliability.

Sign in / Sign up

Export Citation Format

Share Document