Preoperative functional mapping for rolandic brain tumor surgery

The resection of tumors within or close to eloquent motor areas is usually guided by the compromise between the maximal allowed resection and preservation of neurological functions. Navigated transcranial magnetic stimulation (nTMS) is an emerging technology that can be used for preoperative mapping of the motor cortex. We performed pre-surgical mapping by using nTMS in 17 patients with lesions in or close to the precentral gyrus. The study was conducted on consecutive patients scheduled for surgical treatment. nTMS allowed to exactly localize the motor cortex in 88.2% of cases. In 70.6% it provided the surgeon with new unexpected information about functional anatomy of the motor area, influencing the pre-operative planning. Moreover, in 29.4% these functional information had a clear impact on surgery, making necessary a change of surgical strategy to avoid damage to the motor cortex. Our results prove that nTMS has a large benefit in the treatment of rolandic brain tumors. It adds important information about spatial relationship between functional motor cortex and the tumor and reduces surgical-related post-operative motor deficits.

[1]  Nick F Ramsey,et al.  The role of functional magnetic resonance imaging in brain surgery , 2011 .

[2]  W F Taylor,et al.  Neurosurgical management of low-grade astrocytoma of the cerebral hemispheres. , 1984, Journal of neurosurgery.

[3]  Antti Korvenoja,et al.  Somatotopic blocking of sensation with navigated transcranial magnetic stimulation of the primary somatosensory cortex , 2005, Human brain mapping.

[4]  Phiroz E. Tarapore,et al.  Preoperative multimodal motor mapping: a comparison of magnetoencephalography imaging, navigated transcranial magnetic stimulation, and direct cortical stimulation. , 2012, Journal of neurosurgery.

[5]  Zhen Jiang,et al.  Impaired fMRI activation in patients with primary brain tumors , 2010, NeuroImage.

[6]  Alfredo Quinones-Hinojosa,et al.  ASSOCIATION OF SURGICALLY ACQUIRED MOTOR AND LANGUAGE DEFICITS ON OVERALL SURVIVAL AFTER RESECTION OF GLIOBLASTOMA MULTIFORME , 2009, Neurosurgery.

[7]  P. Rossini,et al.  Non-invasive electrical and magnetic stimulation of the brain, spinal cord and roots: basic principles and procedures for routine clinical application. Report of an IFCN committee. , 1994, Electroencephalography and clinical neurophysiology.

[8]  P. Vajkoczy,et al.  Assessing the functional status of the motor system in brain tumor patients using transcranial magnetic stimulation , 2012, Acta Neurochirurgica.

[9]  Dietmar Frey,et al.  Navigated transcranial magnetic stimulation improves the treatment outcome in patients with brain tumors in motor eloquent locations. , 2014, Neuro-oncology.

[10]  B. Meyer,et al.  Utility of presurgical navigated transcranial magnetic brain stimulation for the resection of tumors in eloquent motor areas. , 2012, Journal of neurosurgery.

[11]  R. Lyle A performance test for assessment of upper limb function in physical rehabilitation treatment and research , 1981, International journal of rehabilitation research. Internationale Zeitschrift fur Rehabilitationsforschung. Revue internationale de recherches de readaptation.

[12]  Veit Rohde,et al.  EXTENT OF RESECTION AND SURVIVAL IN GLIOBLASTOMA MULTIFORME: IDENTIFICATION OF AND ADJUSTMENT FOR BIAS , 2008, Neurosurgery.

[13]  Dietmar Frey,et al.  Preoperative Functional Mapping for Rolandic Brain Tumor Surgery: Comparison of Navigated Transcranial Magnetic Stimulation to Direct Cortical Stimulation , 2011, Neurosurgery.

[14]  Bernhard Meyer,et al.  Preoperative motor mapping by navigated transcranial magnetic brain stimulation improves outcome for motor eloquent lesions. , 2014, Neuro-oncology.

[15]  B R Rosen,et al.  Functional magnetic resonance imaging and transcranial magnetic stimulation , 1997, Neurology.

[16]  Karl J. Friston,et al.  Functional Connectivity: The Principal-Component Analysis of Large (PET) Data Sets , 1993, Journal of cerebral blood flow and metabolism : official journal of the International Society of Cerebral Blood Flow and Metabolism.

[17]  Peter Vajkoczy,et al.  Assessment of the influence of navigated transcranial magnetic stimulation on surgical planning for tumors in or near the motor cortex. , 2012, Neurosurgery.

[18]  B. Scheithauer,et al.  The 2007 WHO classification of tumours of the central nervous system , 2007, Acta Neuropathologica.

[19]  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.

[20]  M Hallett,et al.  A theoretical calculation of the electric field induced in the cortex during magnetic stimulation. , 1991, Electroencephalography and clinical neurophysiology.

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

[22]  H. Duffau Introduction. Surgery of gliomas in eloquent areas: from brain hodotopy and plasticity to functional neurooncology. , 2010, Neurosurgical focus.

[23]  M. Hallett Transcranial magnetic stimulation and the human brain , 2000, Nature.

[24]  Benjamin J. Tamber-Rosenau,et al.  Decoding cognitive control in human parietal cortex , 2009, Proceedings of the National Academy of Sciences.

[25]  Olaf Sporns,et al.  THE HUMAN CONNECTOME: A COMPLEX NETWORK , 2011, Schizophrenia Research.

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

[27]  M. Berger,et al.  GLIOMA EXTENT OF RESECTION AND ITS IMPACT ON PATIENT OUTCOME , 2008, Neurosurgery.

[28]  Thomas Kahn,et al.  Sulcus topography of the parietal opercular region: An anatomic and MR study , 1990, Brain and Language.

[29]  R Salmelin,et al.  The 3D topography of MEG source localization accuracy: effects of conductor model and noise , 2003, Clinical Neurophysiology.

[30]  J. Sarvas Basic mathematical and electromagnetic concepts of the biomagnetic inverse problem. , 1987, Physics in medicine and biology.