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

363 Cortical Plasticity of Motor-Eloquent Areas Measured by Navigated Transcranial Magnetic Stimulation in Glioma Patients

Neurosurgery ◽  
2016 ◽  
Vol 63 ◽  
pp. 207-208 ◽  
Author(s):  
Neal Conway ◽  
Noriko Tanigawa ◽  
Bernhard Meyer ◽  
Sandro M. Krieg
Keyword(s):  
Transcranial Magnetic Stimulation ◽  
Magnetic Stimulation ◽  
Cortical Plasticity ◽  
Navigated Transcranial Magnetic Stimulation ◽  
Eloquent Areas

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.

Postoperative navigated transcranial magnetic stimulation to predict motor recovery after surgery of tumors in motor eloquent areas

2019 ◽  
Vol 130 (6) ◽  
pp. 952-959 ◽  
Author(s):  
Kathleen Seidel ◽  
Levin Häni ◽  
Katharina Lutz ◽  
Chantal Zbinden ◽  
Annetta Redmann ◽  
...  
Keyword(s):  
Transcranial Magnetic Stimulation ◽  
Magnetic Stimulation ◽  
Motor Recovery ◽  
Navigated Transcranial Magnetic Stimulation ◽  
Eloquent Areas

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.

Pediatric navigated transcranial magnetic stimulation motor and language mapping combined with diffusion tensor imaging tractography: clinical experience

2020 ◽  
Vol 26 (5) ◽  
pp. 583-593
Author(s):  
Tizian Rosenstock ◽  
Thomas Picht ◽  
Heike Schneider ◽  
Peter Vajkoczy ◽  
Ulrich-Wilhelm Thomale
Keyword(s):  
Diffusion Tensor Imaging ◽  
Transcranial Magnetic Stimulation ◽  
Magnetic Stimulation ◽  
Surgical Planning ◽  
Diffusion Tensor ◽  
Fiber Tracking ◽  
Navigated Transcranial Magnetic Stimulation ◽  
Language Mapping ◽  
Eloquent Areas ◽  
Dti Fiber Tracking

OBJECTIVEIn adults, navigated transcranial magnetic stimulation (nTMS) has been established as a preoperative examination method for brain tumors in motor- and language-eloquent locations. However, the clinical relevance of nTMS in children with brain tumors is still unclear. Here, the authors present their initial experience with nTMS-based surgical planning and family counseling in pediatric cases.METHODSThe authors analyzed the feasibility of nTMS and its influence on counseling and surgical strategy in a prospective study conducted between July 2017 and September 2019. The main inclusion criterion was a potential benefit from functional mapping data derived from nTMS and/or nTMS-enhanced tractography in pediatric patients who presented to the authors’ department prior to surgery for lesions close to motor- and/or speech-eloquent areas. The study was undertaken in 14 patients (median age 7 years, 8 males) who presented with different brain lesions.RESULTSMotor mapping combined with cortical seed area definition could be performed in 10 children (71%) to identify the corticospinal tract by additional diffusion tensor imaging (DTI). All motor mappings could be performed successfully without inducing relevant side effects. In 7 children, nTMS language mapping was performed to detect language-relevant cortical areas and DTI fiber tractography was performed to visualize the individual language network. nTMS examination was not possible in 4 children because of lack of compliance (n = 2), syncope (n = 1), and preexisting implant (n = 1). After successful mapping, the spatial relation between lesion and functional tissue was used for surgical planning in all 10 patients, and 9 children underwent nTMS-DTI integrated neuronavigation. No surgical complications or unexpected neurological deterioration was observed. In all successful nTMS cases, better function-based counseling was offered to the families. In 6 of 10 patients the surgical strategy was adapted according to nTMS data, and in 6 of 10 cases the extent of resection (EOR) was redefined.CONCLUSIONSnTMS and DTI fiber tracking were feasible for the majority of children. Presurgical counseling as well as surgical planning for the approach and EOR were improved by the nTMS examination results. nTMS in combination with DTI fiber tracking can be regarded as beneficial for neurosurgical procedures in eloquent areas in the pediatric population.

scholarly journals 306 Postoperative Navigated Transcranial Magnetic Stimulation to Predict Motor Recovery After Surgery of Tumors Located in Motor Eloquent Areas

Neurosurgery ◽  
2018 ◽  
Vol 65 (CN_suppl_1) ◽  
pp. 124-124 ◽  
Author(s):  
Kathleen Seidel ◽  
Levin Häni ◽  
Katharina Lutz ◽  
Chantal Zbinden ◽  
Annetta Redmann ◽  
...  
Keyword(s):  
Transcranial Magnetic Stimulation ◽  
Magnetic Stimulation ◽  
Motor Recovery ◽  
Navigated Transcranial Magnetic Stimulation ◽  
Eloquent Areas

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.

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.

Cortical plasticity of motor-eloquent areas measured by navigated transcranial magnetic stimulation in patients with glioma

2017 ◽  
Vol 127 (5) ◽  
pp. 981-991 ◽  
Author(s):  
Neal Conway ◽  
Noémie Wildschuetz ◽  
Tobias Moser ◽  
Lucia Bulubas ◽  
Nico Sollmann ◽  
...  
Keyword(s):  
Transcranial Magnetic Stimulation ◽  
Magnetic Stimulation ◽  
Cortical Plasticity ◽  
High Grade Glioma ◽  
Low Grade ◽  
Precentral Gyrus ◽  
Navigated Transcranial Magnetic Stimulation ◽  
Motor Representation ◽  
Anteroposterior Axis ◽  
Rolandic Region

OBJECTIVEThe goal of this study was to obtain a better understanding of the mechanisms underlying cerebral plasticity. Coupled with noninvasive detection of its occurrence, such an understanding has huge potential to improve glioma therapy. The authors aimed to demonstrate the frequency of plastic reshaping, find clues to the patterns behind it, and prove that it can be recognized noninvasively using navigated transcranial magnetic stimulation (nTMS).METHODSThe authors used nTMS to map cortical motor representation in 22 patients with gliomas affecting the precentral gyrus, preoperatively and 3–42 months postoperatively. Location changes of the primary motor area, defined as hotspots and map centers of gravity, were measured.RESULTSSpatial normalization and analysis of hotspots showed an average shift of 5.1 ± 0.9 mm (mean ± SEM) on the mediolateral axis, and 10.7 ± 1.6 mm on the anteroposterior axis. Map centers of gravity were found to have shifted by 4.6 ± 0.8 mm on the mediolateral, and 8.7 ± 1.5 mm on the anteroposterior axis. Motor-eloquent points tended to shift toward the tumor by 4.5 ± 3.6 mm if the lesion was anterior to the rolandic region and by 2.6 ± 3.3 mm if it was located posterior to the rolandic region. Overall, 9 of 16 (56%) patients with high-grade glioma and 3 of 6 (50%) patients with low-grade glioma showed a functional shift > 10 mm at the cortical level.CONCLUSIONSDespite the small size of this series, analysis of these data showed that cortical functional reorganization occurs quite frequently. Moreover, nTMS was shown to detect such plastic reorganization noninvasively.

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