gms | German Medical Science

62nd Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Polish Society of Neurosurgeons (PNCH)

German Society of Neurosurgery (DGNC)

7 - 11 May 2011, Hamburg

Accuracy of preoperative navigated brain stimulation for surgery in central region tumors

Meeting Abstract

  • S. Krieg - Neurochirurgische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München
  • E. Shiban - Neurochirurgische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München
  • N. Buchmann - Neurochirurgische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München
  • J. Gempt - Neurochirurgische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München
  • B. Meyer - Neurochirurgische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München
  • F. Ringel - Neurochirurgische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München

Deutsche Gesellschaft für Neurochirurgie. Polnische Gesellschaft für Neurochirurgen. 62. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgen (PNCH). Hamburg, 07.-11.05.2011. Düsseldorf: German Medical Science GMS Publishing House; 2011. DocP 072

DOI: 10.3205/11dgnc293, URN: urn:nbn:de:0183-11dgnc2936

Published: April 28, 2011

© 2011 Krieg et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.


Outline

Text

Objective: Navigated brain stimulation (NBS) is a newly evolving technique. Except for its supposed purpose, e.g. for preoperative mapping of the central region, little is known about its accuracy compared to more commonly used modalities like direct cortical stimulation (DCS) and functional MRI (fMRI).

Methods: We examined 14 patients with tumors in or close to the precentral gyrus as well as 12 cases of lesions in the subcortical white matter motor tract using NBS for motor cortex characterization.

Results: In the 14 cases of lesions within the precentral gyrus, preoperative motor cortex characterization correlated well with intraoperative DCS with a deviation of 4.4 ± 3.4 mm. Comparing NBS with fMRI, however, deviation was quite larger with 9.8 ± 8.5 mm for upper and 14.7 ± 12.4 mm for lower extremity. In 13 out of 14 cases the surgeon admitted easier identification of the central region whereas it increased confidence in 7 cases. In 5 out of 14 cases, the surgeon recognized a positive influence from the NBS data on the operative result, while it even changed the resection strategy in 2 cases. In 12 patients with subcortical lesions, DTI fiber tracking was performed using NBS mapping as seed region, which resulted in a subjectively more specific presentation of the corticospinal tract compared to conventional fiber tracking. In combination with navigated subcortical mapping, these data are quite useful to confirm each other during resection. One out of 26 patients experienced NBS to be "unpleasant", no one as "painful".

Conclusions: NBS correlates well with DCS as gold standard despite factors, which are supposed to contribute to inaccuracy of the method. Moreover, NBS is shown to be accepted by the surgeon as an additional and helpful modality during resection of tumors within motor eloquent areas but also during preoperative planning.