Setup presentation and clinical outcome analysis of treating highly language-eloquent gliomas via preoperative navigated transcranial magnetic stimulation and tractography

Neurosurgical Focus
Nico SollmannSandro M Krieg

Abstract

OBJECTIVE Awake surgery combined with intraoperative direct electrical stimulation (DES) and intraoperative neuromonitoring (IONM) is considered the gold standard for the resection of highly language-eloquent brain tumors. Different modalities, such as functional magnetic resonance imaging (fMRI) or magnetoencephalography (MEG), are commonly added as adjuncts for preoperative language mapping but have been shown to have relevant limitations. Thus, this study presents a novel multimodal setup consisting of preoperative navigated transcranial magnetic stimulation (nTMS) and nTMS-based diffusion tensor imaging fiber tracking (DTI FT) as an adjunct to awake surgery. METHODS Sixty consecutive patients (63.3% men, mean age 47.6 ± 13.3 years) suffering from highly language-eloquent left-hemispheric low- or high-grade glioma underwent preoperative nTMS language mapping and nTMS-based DTI FT, followed by awake surgery for tumor resection. Both nTMS language mapping and DTI FT data were available for resection planning and intraoperative guidance. Clinical outcome parameters, including craniotomy size, extent of resection (EOR), language deficits at different time points, Karnofsky Performance Scale (KPS) score, duration of surgery, and ...Continue Reading

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Citations

Oct 7, 2018·Journal of Neurosurgical Sciences·Marco Conti NibaliLorenzo Bello
Sep 28, 2018·Journal of Neurosurgical Sciences·Chase H FosterAaron Cohen-Gadol
Mar 17, 2020·Journal of Neurological Surgery. Part A, Central European Neurosurgery·Tim WendeJürgen Meixensberger
Sep 27, 2018·Frontiers in Behavioral Neuroscience·Nico SollmannSandro M Krieg
Jun 14, 2019·Frontiers in Oncology·Jamie D CostabileD Ryan Ormond

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Methods Mentioned

BETA
sedation

Software Mentioned

GraphPad Prism
GraphPad
Nexstim
eXimia NBS
BrainLAB iPlan Net server

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