Navigated Transcranial Magnetic Stimulation and Functional Magnetic Resonance Imaging: Advanced Adjuncts in Preoperative Planning for Central Region Tumors

BACKGROUND:Tumor resection in the vicinity of the motor cortex poses a challenge to all neurosurgeons. For preoperative assessment of eloquent cortical areas, functional magnetic resonance imaging (fMRI) is used, whereas intraoperatively, direct cortical stimulation (DCS) is performed. Navigated transcranial magnetic stimulation (nTMS) is comparable to DCS in activating cortical pyramidal neurons. OBJECTIVE:To evaluate the reliability of nTMS compared with fMRI and DCS for preoperative resection planning of centrally located tumors. METHODS:In a prospective series, 11 patients (ages, 20-63 years; mean, 41.9 ± 14.9 years, 2 women) with tumors located in or adjacent to the motor cortex were evaluated for surgery. fMRI and nTMS were applied for preoperative assessment of the extent of tumor resection. A 3-dimensional anatomic data set with superimposed fMRI data was integrated in the eXimia Navigated Brain Stimulation station for ensuing motor cortex mapping by nTMS. Responses from nTMS were evaluated by electromyographic response. During surgery, the coordinates of each DCS site were unambiguously defined and integrated into neuronavigation. A post hoc comparison of the coordinates of nTMS, fMRI, and DCS was performed. RESULTS:Distances from nTMS to DCS (10.5 ± 5.67 mm) were significantly smaller than those from fMRI to DCS (15.0 ± 7.6 mm). CONCLUSION:nTMS anticipates information usually only enabled by DCS and therefore allows surgical planning in eloquent cortex surgery.

[1]  R. S. Hinks,et al.  Time course EPI of human brain function during task activation , 1992, Magnetic resonance in medicine.

[2]  S. Boniface,et al.  Magnetic brain stimulation with a double coil: the importance of coil orientation. , 1992, Electroencephalography and clinical neurophysiology.

[3]  Christopher Nimsky,et al.  Intraoperative functional MRI: Implementation and preliminary experience , 2005, NeuroImage.

[4]  Daniela Balslev,et al.  Inter-individual variability in optimal current direction for transcranial magnetic stimulation of the motor cortex , 2007, Journal of Neuroscience Methods.

[5]  U. D. Schmid,et al.  Safe surgery of lesions near the motor cortex using intra-operative mapping techniques: a report on 50 patients , 2005, Acta Neurochirurgica.

[6]  Andreas Raabe,et al.  Functional Magnetic Resonance Imaging-integrated Neuronavigation: Correlation between Lesion-to-Motor Cortex Distance and Outcome , 2004, Neurosurgery.

[7]  Functional magnetic resonance imaging and cortical mapping in motor cortex tumor surgery: complementary methods. , 2008, Zentralblatt fur Neurochirurgie.

[8]  Simone Rossi,et al.  Transcranial magnetic stimulation , 2007, Neurology.

[9]  Antti Korvenoja,et al.  Sensorimotor cortex localization: comparison of magnetoencephalography, functional MR imaging, and intraoperative cortical mapping. , 2006, Radiology.

[10]  O. Salonen,et al.  Navigated transcranial magnetic stimulation of the primary somatosensory cortex impairs perceptual processing of tactile temporal discrimination , 2008, Neuroscience Letters.

[11]  Stéphane Lehéricy,et al.  Long-term brain plasticity allowing a multistage surgical approach to World Health Organization Grade II gliomas in eloquent areas. , 2008, Journal of neurosurgery.

[12]  Nick F. Ramsey,et al.  Within-subject variation in BOLD-fMRI signal changes across repeated measurements: Quantification and implications for sample size , 2008, NeuroImage.

[13]  Gereon R. Fink,et al.  Neuronavigation for transcranial magnetic stimulation (TMS): Where we are and where we are going , 2010, Cortex.

[14]  J. Mäkelä,et al.  Magnetoencephalography in Neurosurgery , 2006, Neurosurgery.

[15]  J. Rothwell,et al.  The physiological basis of transcranial motor cortex stimulation in conscious humans , 2004, Clinical Neurophysiology.

[16]  H. Brückmann,et al.  Reproducibility of activation in four motor paradigms. An fMRI study. , 2006, Journal of neurology.

[17]  Paul Ferrari,et al.  Preoperative magnetic source imaging for brain tumor surgery: a quantitative comparison with intraoperative sensory and motor mapping. , 2002, Neurosurgical focus.

[18]  Peter Vajkoczy,et al.  NAVIGATED TRANSCRANIAL MAGNETIC STIMULATION FOR PREOPERATIVE FUNCTIONAL DIAGNOSTICS IN BRAIN TUMOR SURGERY , 2009, Neurosurgery.

[19]  Christos Trantakis,et al.  Investigation of time-dependency of intracranial brain shift and its relation to the extent of tumor removal using intra-operative MRI , 2003, Neurological research.

[20]  R. Turner,et al.  Dynamic magnetic resonance imaging of human brain activity during primary sensory stimulation. , 1992, Proceedings of the National Academy of Sciences of the United States of America.

[21]  O. Suess,et al.  Intra-Operative Mapping of the Motor Cortex During Surgery in and Around the Motor Cortex , 2000, Acta Neurochirurgica.

[22]  A. Barker,et al.  NON-INVASIVE MAGNETIC STIMULATION OF HUMAN MOTOR CORTEX , 1985, The Lancet.

[23]  P. Woerdeman,et al.  Application accuracy in frameless image-guided neurosurgery: a comparison study of three patient-to-image registration methods. , 2007, Journal of neurosurgery.

[24]  D Le Bihan,et al.  Correspondence between functional magnetic resonance imaging somatotopy and individual brain anatomy of the central region: comparison with intraoperative stimulation in patients with brain tumors. , 2000, Journal of neurosurgery.

[25]  Alvaro Pascual-Leone,et al.  Impact of repetitive transcranial magnetic stimulation of the parietal cortex on metabolic brain activity: a 14C-2DG tracing study in the cat , 2005, Experimental Brain Research.

[26]  A Thron,et al.  Navigated Transcranial Magnetic Stimulation for Presurgical Planning , 2001 .

[27]  Juha Silvanto,et al.  State-Dependency of Transcranial Magnetic Stimulation , 2008, Brain Topography.

[28]  H Duffau,et al.  Contribution of intraoperative electrical stimulations in surgery of low grade gliomas: a comparative study between two series without (1985–96) and with (1996–2003) functional mapping in the same institution , 2005, Journal of Neurology, Neurosurgery & Psychiatry.

[29]  M Zaitsev,et al.  Point spread function mapping with parallel imaging techniques and high acceleration factors: Fast, robust, and flexible method for echo‐planar imaging distortion correction , 2004, Magnetic resonance in medicine.

[30]  D. Altman,et al.  Measuring agreement in method comparison studies , 1999, Statistical methods in medical research.

[31]  R. Töpper,et al.  Localization of the motor hand area using transcranial magnetic stimulation and functional magnetic resonance imaging , 1999, Clinical Neurophysiology.

[32]  J. Rothwell,et al.  How does transcranial magnetic stimulation modify neuronal activity in the brain? Implications for studies of cognition , 2009, Cortex.

[33]  Esa Mervaala,et al.  Motor Potentials Evoked by Navigated Transcranial Magnetic Stimulation in Healthy Subjects , 2008, Journal of clinical neurophysiology : official publication of the American Electroencephalographic Society.

[34]  J C Rothwell,et al.  Comparison of descending volleys evoked by transcranial magnetic and electric stimulation in conscious humans. , 1998, Electroencephalography and clinical neurophysiology.

[35]  Alexandra Golby,et al.  FUNCTIONAL BRAIN MAPPING AND ITS APPLICATIONS TO NEUROSURGERY , 2007, Neurosurgery.

[36]  Christopher Nimsky,et al.  Correlation of Sensorimotor Activation with Functional Magnetic Resonance Imaging and Magnetoencephalography in Presurgical Functional Imaging: A Spatial Analysis , 2001, NeuroImage.

[37]  L. Joskowicz,et al.  Surface-based facial scan registration in neuronavigation procedures: a clinical study. , 2009, Journal of neurosurgery.

[38]  Uri Eden,et al.  Biophysical foundations underlying TMS: Setting the stage for an effective use of neurostimulation in the cognitive neurosciences , 2009, Cortex.

[39]  Robert Chen,et al.  The clinical diagnostic utility of transcranial magnetic stimulation: Report of an IFCN committee , 2008, Clinical Neurophysiology.