Intraoperative Functional Mapping by Direct Cortical Stimulation : For Brain Tumor Operation under Local Anesthesia

Abstract Objective: Transcranial magnetic stimulation (TMS) is a noninvasive method for analyzing cortical function. To utilize TMS for presurgical functional diagnostics, the magnetic impulse must be precisely targeted by stereotactically positioning the coil. The aim of this study was to evaluate the usefulness of TMS for operation planning when combined with a sensor-based electromagnetic navigation system (nTMS). Methods: Preoperative functional mapping with nTMS was performed in 10 patients with rolandic tumors. Intraoperative mapping was performed with the “gold standard” of direct cortical stimulation. Stimulation was performed in the same predefined 5-mm raster for both modalities, and the results were compared. Results: In regard to the 5-mm mapping raster, the centers of gravity of nTMS and direct cortical stimulation were located at the same spot in 4 cases and at neighboring spots in the remaining 6 cases. The mean distance between the tumor and the nearest motor response (“safety margin”) was 7.9 mm (range, 5–15 mm; standard deviation, 3.2 mm) for nTMS and 6.6 mm (range, 0–12 mm; standard deviation, 3.4 mm) for direct cortical stimulation. Conclusion: nTMS allowed for reliable, precise application of the magnetic impulse, and the peritumoral somatotopy corresponded well between the 2 modalities in all 10 cases. nTMS is a promising method for preoperative functional mapping in motor cortex tumor surgery.

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Usefulness of Direct Cortical Stimulation During Intraoperative Monitoring in Patients with Brain Tumor Near Motor Cortex: Case Report

Korean Journal of Clinical Laboratory Science ◽

10.15324/kjcls.2018.50.2.211 ◽

2018 ◽

Vol 50 (2) ◽

pp. 211-215 ◽

Cited By ~ 2

Author(s):

Sung-Hyuk Lim ◽

Sang-Ku Park ◽

Dong-Jun Kim ◽

Jae-Seung Baek ◽

Chan-Woo Park

Keyword(s):

Brain Tumor ◽

Case Report ◽

Motor Cortex ◽

Intraoperative Monitoring ◽

Cortical Stimulation ◽

Direct Cortical Stimulation

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Sources of Variation Influencing Concordance between Functional MRI and Direct Cortical Stimulation in Brain Tumor Surgery

Frontiers in Neuroscience ◽

10.3389/fnins.2016.00461 ◽

2016 ◽

Vol 10 ◽

Cited By ~ 10

Author(s):

Melanie A. Morrison ◽

Fred Tam ◽

Marco M. Garavaglia ◽

Gregory M. T. Hare ◽

Michael D. Cusimano ◽

...

Keyword(s):

Brain Tumor ◽

Functional Mri ◽

Cortical Stimulation ◽

Tumor Surgery ◽

Brain Tumor Surgery ◽

Direct Cortical Stimulation ◽

Sources Of Variation

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Language Mapping Using fMRI and Direct Cortical Stimulation for Brain Tumor Surgery

Topics in Magnetic Resonance Imaging ◽

10.1097/rmr.0000000000000074 ◽

2016 ◽

Vol 25 (1) ◽

pp. 1-10 ◽

Cited By ~ 20

Author(s):

Nicole Petrovich Brennan ◽

Kyung K. Peck ◽

Andrei Holodny

Keyword(s):

Brain Tumor ◽

Cortical Stimulation ◽

Tumor Surgery ◽

Brain Tumor Surgery ◽

Language Mapping ◽

Direct Cortical Stimulation

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O2-D-34. Functional mapping of praxis network: A combined direct cortical stimulation and CCEP study

Clinical Neurophysiology ◽

10.1016/j.clinph.2013.02.081 ◽

2013 ◽

Vol 124 (8) ◽

pp. e31

Author(s):

Akihiro Shimotake ◽

Riki Matsumoto ◽

Takeharu Kunieda ◽

Nobuhiro Mikuni ◽

Hidenao Fukuyama ◽

...

Keyword(s):

Functional Mapping ◽

Cortical Stimulation ◽

Direct Cortical Stimulation

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First preoperative functional mapping via navigated transcranial magnetic stimulation in a 3-year-old boy

Journal of Neurosurgery Pediatrics ◽

10.3171/2012.2.peds11426 ◽

2012 ◽

Vol 9 (6) ◽

pp. 660-664 ◽

Cited By ~ 13

Author(s):

Jan Coburger ◽

Jari Karhu ◽

Markus Bittl ◽

Nikolai J. Hopf

Keyword(s):

Transcranial Magnetic Stimulation ◽

Motor Cortex ◽

Magnetic Stimulation ◽

Functional Mapping ◽

Cortical Stimulation ◽

Navigated Transcranial Magnetic Stimulation ◽

Direct Cortical Stimulation ◽

First Case ◽

Preoperative Mapping ◽

Motor Cortex Mapping

Preoperative functional mapping in children younger than 5 years old remains a challenge. Awake functional MRI (fMRI) is usually not an option for these patients. Except for a description of passive fMRI in sedated patients and magnetoencephalography, no other noninvasive mapping method has been reported as a preoperative diagnostic tool in children. Therefore, invasive intraoperative direct cortical stimulation remains the method of choice. To the authors' knowledge, this is the first case of a young child undergoing preoperative functional motor cortex mapping with the aid of navigated transcranial magnetic stimulation (nTMS). In this 3-year-old boy with a rolandic ganglioglioma, awake preoperative mapping was performed using nTMS. A precise location of Broca area 4 could be established. The surgical approach was planned according to the preoperative findings. Intraoperative direct cortical stimulation verified the location of the nTMS hotspots, and complete resection of the precentral tumor was achieved. Navigated TMS is a precise tool for preoperative motor cortex mapping and is feasible even in very young pediatric patients. In children for whom performing the fMRI motor paradigm is challenging, nTMS is the only available option for functional mapping.

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Cutoff Points, Sensitivities, and Specificities of Intraoperative Motor-Evoked Potential Monitoring Determined Using Receiver Operating Characteristic Analysis

Journal of Neurological Surgery Part A Central European Neurosurgery ◽

10.1055/s-0038-1676623 ◽

2018 ◽

Vol 80 (02) ◽

pp. 102-108

Author(s):

Jiro Akimoto ◽

Ryo Hashimoto ◽

Junko Takanashi ◽

Hidehiro Oka ◽

Satoshi Tanaka

Keyword(s):

Brain Tumor ◽

Receiver Operating Characteristic ◽

Sensitivity And Specificity ◽

Evoked Potential ◽

Operating Characteristic ◽

Motor Evoked Potential ◽

Cortical Stimulation ◽

Transcranial Stimulation ◽

Direct Cortical Stimulation ◽

Cutoff Points

Background Although intraoperative motor-evoked potential (MEP) monitoring is widely performed during neurosurgical operations, evaluating its results is controversial. Study Aims The cutoff point of MEP monitoring should be determined not only to predict but also to prevent postoperative neurologic deficits. Material and Methods MEP monitoring was performed during 484 neurosurgical operations for patients without definitive preoperative motor palsy including 325 spinal operations, 102 cerebral aneurysmal operations, and 57 brain tumor operations, all monitored by transcranial stimulation, and 34 brain tumor operations monitored under direct cortical stimulation. To exclude the effects of muscle relaxants on MEP, the compound muscle action potential (CMAP), measured immediately after transcranial stimulation or direct cortical stimulation at supramaximal stimulation of the peripheral nerve, was used for normalization. The cutoff points, sensitivity, and specificity of MEP recorded during neurosurgery were examined by receiver operating characteristic (ROC) analyses and categorized according to the type of operation and stimulation. Results In spinal operations under transcranial stimulation, amplitude reduction of 77.9% and 80.6% as cutoff points for motor palsy with and without CMAP normalization, respectively, provided a sensitivity of 100% and specificity of 96.8% and 96.5%. In aneurysmal operations under transcranial stimulation, cutoff points of 70.7% and 69.6% offered specificities of 95.2% and 95.7% with and without CMAP normalization, respectively. The sensitivities for both were 100%. In brain tumor operations under direct stimulation, cutoff points were 83.5% and 86.3% with or without CMAP normalization, respectively, and the sensitivity and specificity for both were 100%. Conclusion An amplitude decrease of 80% in brain tumor operations, 75% in spinal operations, and 70% in aneurysmal operations should be used as the cutoff points.

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Determination of the threshold for convulsions by direct cortical stimulation

Epilepsy Research ◽

10.1016/0920-1211(89)90039-9 ◽

1989 ◽

Vol 3 (2) ◽

pp. 120-129 ◽

Cited By ~ 42

Author(s):

R.A Voskuyl ◽

J Dingemanse ◽

M Danhof

Keyword(s):

Cortical Stimulation ◽

Direct Cortical Stimulation

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Impairment of preoperative language mapping by lesion location: a functional magnetic resonance imaging, navigated transcranial magnetic stimulation, and direct cortical stimulation study

Journal of Neurosurgery ◽

10.3171/2014.10.jns141582 ◽

2015 ◽

Vol 123 (2) ◽

pp. 314-324 ◽

Cited By ~ 42

Author(s):

Sebastian Ille ◽

Nico Sollmann ◽

Theresa Hauck ◽

Stefanie Maurer ◽

Noriko Tanigawa ◽

...

Keyword(s):

Transcranial Magnetic Stimulation ◽

Positive Predictive Value ◽

Predictive Value ◽

Magnetic Stimulation ◽

Cortical Stimulation ◽

Awake Surgery ◽

Navigated Transcranial Magnetic Stimulation ◽

Language Mapping ◽

Direct Cortical Stimulation ◽

Neurosurgical Patients

OBJECT Language mapping by repetitive navigated transcranial magnetic stimulation (rTMS) is increasingly used and has already replaced functional MRI (fMRI) in some institutions for preoperative mapping of neurosurgical patients. Yet some factors affect the concordance of both methods with direct cortical stimulation (DCS), most likely by lesions affecting cortical oxygenation levels. Therefore, the impairment of the accuracy of rTMS and fMRI was analyzed and compared with DCS during awake surgery in patients with intraparenchymal lesions. METHODS Language mapping was performed by DCS, rTMS, and fMRI using an object-naming task in 27 patients with left-sided perisylvian lesions, and the induced language errors of each method were assigned to the cortical parcellation system. Subsequently, the receiver operating characteristics were calculated for rTMS and fMRI and compared with DCS as ground truth for regions with (w/) and without (w/o) the lesion in the mapped regions. RESULTS The w/ subgroup revealed a sensitivity of 100% (w/o 100%), a specificity of 8% (w/o 5%), a positive predictive value of 34% (w/o: 53%), and a negative predictive value (NPV) of 100% (w/o: 100%) for the comparison of rTMS versus DCS. Findings for the comparison of fMRI versus DCS within the w/ subgroup revealed a sensitivity of 32% (w/o: 62%), a specificity of 88% (w/o: 60%), a positive predictive value of 56% (w/o: 62%), and a NPV of 73% (w/o: 60%). CONCLUSIONS Although strengths and weaknesses exist for both rTMS and fMRI, the results show that rTMS is less affected by a brain lesion than fMRI, especially when performing mapping of language-negative cortical regions based on sensitivity and NPV.

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