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

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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The role of navigated transcranial magnetic stimulation for surgery of motor-eloquent brain tumors: a systematic review and meta-analysis

Clinical Neurology and Neurosurgery ◽

10.1016/j.clineuro.2019.03.003 ◽

2019 ◽

Vol 180 ◽

pp. 7-17 ◽

Cited By ~ 14

Author(s):

Giovanni Raffa ◽

Antonino Scibilia ◽

Alfredo Conti ◽

Giuseppe Ricciardo ◽

Vincenzo Rizzo ◽

...

Keyword(s):

Systematic Review ◽

Transcranial Magnetic Stimulation ◽

Brain Tumors ◽

Magnetic Stimulation ◽

Meta Analysis ◽

Navigated Transcranial Magnetic Stimulation

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SAFETY ASSESSMENT OF NAVIGATED TRANSCRANIAL MAGNETIC STIMULATION FOR PREOPERATIVE MOTOR MAPPING IN PATIENTS WITH BRAIN TUMORS

Grekov s Bulletin of Surgery ◽

10.24884/0042-4625-2018-177-3-10-13 ◽

2018 ◽

Vol 177 (3) ◽

pp. 10-13

Author(s):

A. Yu. Shcherbuk ◽

M. E. Eroshenko ◽

Yu. A. Shcherbuk

Keyword(s):

Transcranial Magnetic Stimulation ◽

Brain Tumors ◽

Magnetic Stimulation ◽

Safety Assessment ◽

Navigated Transcranial Magnetic Stimulation ◽

Motor Mapping

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RTHP-33. APPLICATION OF PRESURGICAL NAVIGATED TRANSCRANIAL MAGNETIC STIMULATION MOTOR MAPPING FOR ADJUVANT RADIOTHERAPY TREATMENT PLANNING IN PATIENTS WITH BRAIN TUMORS

Neuro-Oncology ◽

10.1093/neuonc/noy148.963 ◽

2018 ◽

Vol 20 (suppl_6) ◽

pp. vi232-vi232

Author(s):

Christian Diehl ◽

Maximilian Schwendner ◽

Nico Sollmann ◽

Markus Oechsner ◽

Bernhard Meyer ◽

...

Keyword(s):

Transcranial Magnetic Stimulation ◽

Brain Tumors ◽

Treatment Planning ◽

Adjuvant Radiotherapy ◽

Magnetic Stimulation ◽

Navigated Transcranial Magnetic Stimulation ◽

Radiotherapy Treatment Planning ◽

Motor Mapping ◽

Radiotherapy Treatment

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

Journal of Neurosurgery ◽

10.3171/2018.12.jns182988 ◽

2020 ◽

Vol 132 (4) ◽

pp. 1033-1042 ◽

Cited By ~ 3

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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