scholarly journals OPTIMIZATION OF SURGICAL APPROACH IN PATIENTS WITH TUMORS OF MOTOR ZONE OF THE CEREBRAL CORTEX ON THE BASIS OF TRANSCRANIAL MAGNETIC STIMULATION AND MAGNETIC RESONANCE TRACTOGRAPHY

2015 ◽  
Vol 174 (6) ◽  
pp. 63-67
Author(s):  
A. Yu. Shcherbuk ◽  
M. E. Eroshenko ◽  
Yu. A. Shcherbuk
Keyword(s):  
Cerebral Cortex ◽  
Transcranial Magnetic Stimulation ◽  
Magnetic Stimulation ◽  
Clinical Case ◽  
Preoperative Planning ◽  
Treatment Approach ◽  
Navigated Transcranial Magnetic Stimulation ◽  
Central Gyrus ◽  
The Brain ◽  
Combined Data

Preoperative planning on the basis of combined data of navigated transcranial magnetic stimulation and MR-tractography give an opportunity to choose an optimal treatment approach in each clinical case. There were performed the examinations in 52 patients with tumors situated in projection of central gyrus. The neurosurgical interference was admitted as inappropriate in 3 (5,8%) patients. The volume of planned operation was reduced in 14 (26,9%) cases. The examination of 15 (28,9%) patients allowed choice of the correct access trajectory. The navigated transcranial magnetic stimulation assisted in performance of more safe removal of neoplasms closed to the functionally meaningful zones of the brain in 20 (38,4%).

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 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 P.094 Incorporating Navigated Transcranial Magnetic Stimulation (nTMS) into the neurosurgical practice: oncological, vascular and research potentials

2019 ◽  
Vol 46 (s1) ◽  
pp. S38-S39
Author(s):  
OH Khan
Keyword(s):  
Transcranial Magnetic Stimulation ◽  
Magnetic Stimulation ◽  
Mass Effect ◽  
Cognitive Outcomes ◽  
Vascular Lesions ◽  
Surgical Approaches ◽  
Phase 2 ◽  
Navigated Transcranial Magnetic Stimulation ◽  
Phase 2 Clinical Trial ◽  
The Brain

Background: Surgical managment of eloquent lesions in the brain require a multidisciplinary approach. Radiographic imaging, such as magnetic resosnance, can provide details of “normal” anatomy however are limited when lesions can distort/displace due to mass effect or neuroplasticity. Functional MRI (fMRI) has limitations due to patient dependent actions can often be limited due oncological or vascular lesions but known to still be near or involving “eloquent” cortex. Navigated transcranial magnetic stimulation (nTMS) provides the physician with the ability to accurately (~2mm error) stimulate cortex of the brain, in a clinical setting, and to understand function of areas of motor and language and incorporate this information into the surgical theatre. Methods: We will present a personal expierience of complex oncological and vascular cases to illustrate how nTMS can assist in the determination of surgical approaches and educating patients of potential morbidities. Will also review potential research opportunities that nTMS provides. Details of Phase 2 clinical trial of nTMS for improving neuro-cognitive outcomes will be discussed. Results: Case ilustrations will be provided. Preliminary results of Phase 2 clinical study will be discussed. Conclusions: Navigated TMS provides another tool in the armamentarium of neurosurgeons to better manage and approach complex and eloquent lesions in the brain.

scholarly journals Navigated transcranial magnetic stimulation in preoperative planning for the treatment of motor area cavernous angiomas

2013 ◽  
pp. 1885 ◽  
Author(s):  
Wellingson Silva Paiva ◽  
Marco Antonio Marcolin ◽  
Edson Bor-Seng-Shu ◽  
Eberval Gadelha Figueiredo ◽  
Manoel Jacobsen Teixeira ◽  
...  
Keyword(s):  
Transcranial Magnetic Stimulation ◽  
Magnetic Stimulation ◽  
Preoperative Planning ◽  
Motor Area ◽  
Navigated Transcranial Magnetic Stimulation ◽  
Cavernous Angiomas

Associations between clinical outcome and tractography based on navigated transcranial magnetic stimulation in patients with language-eloquent brain lesions

2020 ◽  
Vol 132 (4) ◽  
pp. 1033-1042 ◽  
Author(s):  
Nico Sollmann ◽  
Alessia Fratini ◽  
Haosu Zhang ◽  
Claus Zimmer ◽  
Bernhard Meyer ◽  
...  
Keyword(s):  
Transcranial Magnetic Stimulation ◽  
Brain Tumors ◽  
Risk Stratification ◽  
Magnetic Stimulation ◽  
Diffusion Tensor ◽  
Tumor Resection ◽  
Navigated Transcranial Magnetic Stimulation ◽  
Language Mapping ◽  
Significant Difference ◽  
Related Pathway

OBJECTIVENavigated transcranial magnetic stimulation (nTMS) in combination with diffusion tensor imaging fiber tracking (DTI FT) is increasingly used to locate subcortical language-related pathways. The aim of this study was to establish nTMS-based DTI FT for preoperative risk stratification by evaluating associations between lesion-to-tract distances (LTDs) and aphasia and by determining a cut-off LTD value to prevent surgery-related permanent aphasia.METHODSFifty patients with left-hemispheric, language-eloquent brain tumors underwent preoperative nTMS language mapping and nTMS-based DTI FT, followed by tumor resection. nTMS-based DTI FT was performed with a predefined fractional anisotropy (FA) of 0.10, 0.15, 50% of the individual FA threshold (FAT), and 75% FAT (minimum fiber length [FL]: 100 mm). The arcuate fascicle (AF), superior longitudinal fascicle (SLF), inferior longitudinal fascicle (ILF), uncinate fascicle (UC), and frontooccipital fascicle (FoF) were identified in nTMS-based tractography, and minimum LTDs were measured between the lesion and the AF and between the lesion and the closest other subcortical language-related pathway (SLF, ILF, UC, or FoF). LTDs were then associated with the level of aphasia (no/transient or permanent surgery-related aphasia, according to follow-up examinations).RESULTSA significant difference in LTDs was observed between patients with no or only surgery-related transient impairment and those who developed surgery-related permanent aphasia with regard to the AF (FA = 0.10, p = 0.0321; FA = 0.15, p = 0.0143; FA = 50% FAT, p = 0.0106) as well as the closest other subcortical language-related pathway (FA = 0.10, p = 0.0182; FA = 0.15, p = 0.0200; FA = 50% FAT, p = 0.0077). Patients with surgery-related permanent aphasia showed the lowest LTDs in relation to these tracts. Thus, LTDs of ≥ 8 mm (AF) and ≥ 11 mm (SLF, ILF, UC, or FoF) were determined as cut-off values for surgery-related permanent aphasia.CONCLUSIONSnTMS-based DTI FT of subcortical language-related pathways seems suitable for risk stratification and prediction in patients suffering from language-eloquent brain tumors. Thus, the current role of nTMS-based DTI FT might be expanded, going beyond the level of being a mere tool for surgical planning and resection guidance.

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