gms | German Medical Science

58. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e. V. (DGNC)

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

26. bis 29.04.2007, Leipzig

Combination of high resolution transcranial magnetic stimulation and sensor based navigation for preoperative evaluation in motor cortex tumor surgery

Kombination der hochauflösenden transkraniellen Magnetstimulation mit der sensorbasierten Navigation zur Funktionsanalyse vor Eingriffen im Bereich der Zentralregion

Meeting Abstract

  • corresponding author T. Picht - Neurochirurgische Klinik, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin
  • S. Mularski - Neurochirurgische Klinik, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin
  • B. Kuehn - Neurochirurgische Klinik, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin
  • M. Brock - Neurochirurgische Klinik, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin
  • T. Kombos - Neurochirurgische Klinik, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin
  • O. Suess - Neurochirurgische Klinik, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin

Deutsche Gesellschaft für Neurochirurgie. 58. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC). Leipzig, 26.-29.04.2007. Düsseldorf: German Medical Science GMS Publishing House; 2007. DocSA.01.08

Die elektronische Version dieses Artikels ist vollständig und ist verfügbar unter: http://www.egms.de/de/meetings/dgnc2007/07dgnc138.shtml

Veröffentlicht: 11. April 2007

© 2007 Picht et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielf&aauml;ltigt, verbreitet und &oauml;ffentlich zug&aauml;nglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Objective: Transcranial magnetic stimulation (TMS) is a time and cost effective method for non-invasive analysis of cortical function. In contrast to the widely-used functional magnetic resonance imaging, TMS is as a method of functional testing methodologically comparable to the current gold standard of direct electrocortical stimulation. By combining a high resolution figure-of-eight coil of 35 mm in diameter with a sensor based navigation system, we intended to improve the accuracy and the usability of TMS in the preoperative work up. In a series of 20 patients, we analyzed the feasibility and compared the accuracy of the high resolution sensor based navigated TMS to the results of the intraoperative direct electrocortical mapping.

Methods: A TMS system with a figure-of-eight coil of 35 mm in diameter was combined with a sensor-based navigation system by integrating a sensor into the coil handle. During the examination, another sensor was attached to the patient's head, which made fixation of the head dispensible. 20 patients with lesions in the vicinity of Bodman area 4 were preoperatively evaluated by stimulation of the cortex around the lesion with the high resolution navigated TMS. The result of each stimulation point (stimulus intensity and resulting compound muscle action potential) was documented within the 3D MRI navigational dataset. During the operation, direct electrocortical mapping was carried out in the same pattern.

Results: The function of the sensor based navigation of the TMS coil was reliable. The high resolution figure-of-eight coil allowed for eliciting muscle action potentials in distinct muscle groups of the contralateral extremity. A detailed cartography of the peritumoral cortical motor function could be established in all cases by means of TMS as well as direct electrocortical stimulation. For both methods, the distance between tumor margin and nearest motor area was calculated using the cartesian coordinates. The results were consistent in all cases (mean difference 4.6 mm, range 2.3 - 7.5 mm).

Conclusions: High resolution sensor based navigated TMS is an easy to use and reliable method for evaluating the spatial relation between tumor and motor cortex preoperatively. In this pilot study its results were consistent with the current gold standard of direct electrocortical mapping.