gms | German Medical Science

63rd Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Japanese Neurosurgical Society (JNS)

German Society of Neurosurgery (DGNC)

13 - 16 June 2012, Leipzig

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Risk-benefit balancing in rolandic tumor surgery using navigated transcranial magnetic stimulation

Meeting Abstract

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  • T. Picht - Neurochirurgische Klinik und Hochschulambulanz, Charité - Universitätsmedizin Berlin
  • V. Strack - Neurochirurgische Klinik und Hochschulambulanz, Charité - Universitätsmedizin Berlin
  • J. Schulz - Neurochirurgische Klinik und Hochschulambulanz, Charité - Universitätsmedizin Berlin
  • S. Schilt - Neurochirurgische Klinik und Hochschulambulanz, Charité - Universitätsmedizin Berlin
  • D. Jussen - Neurochirurgische Klinik und Hochschulambulanz, Charité - Universitätsmedizin Berlin
  • P. Vajkoczy - Neurochirurgische Klinik und Hochschulambulanz, Charité - Universitätsmedizin Berlin

Deutsche Gesellschaft für Neurochirurgie. Japanische Gesellschaft für Neurochirurgie. 63. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie (JNS). Leipzig, 13.-16.06.2012. Düsseldorf: German Medical Science GMS Publishing House; 2012. DocDO.11.07

doi: 10.3205/12dgnc105, urn:nbn:de:0183-12dgnc1052

Published: June 4, 2012

© 2012 Picht 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: Corresponding to the literature after glioma surgery the motor function can be improved in 4–35% and deteriorated in 4–19%. Unfortunately, there are no prognostic data. The aim of the present study was to analyze the results from preoperative navigated transcranial magnetic stimulation (nTMS) for their predictive value in regard to motor function.

Methods: In 150 consecutive patients preoperative nTMS mapping was performed and the location of the tumor in relation to the primary motor cortex (M1) was determined. In addition a motor excitability ratio was calculated by measurement of the resting motor threshold (RMT) both on the tumorous and the healthy hemisphere. The functional status was documented preoperatively and 3 month postoperatively. Multinomial logistic regression analysis was used to determine which variables were associated with permanent changes in the motor status.

Results: Motor excitability showed wide variability with the majority of patients having a pathological difference between the tumorous and healthy hemisphere. Intact preoperative motor status, tumour in contact to M1 and decreased motor excitability on the tumour side are the variables with the highest predictive value for a new/increased neurological deficit postoperatively. Recovery from an existing motor deficit was most likely in patients with a precentral tumor and normal motor excitability ratio.

Conclusions: Neurophysiological assessment of the patient’s motor system in addition to topographical mapping by means of nTMS allows for objective risk-benefit balancing before surgery in the vicinity of essential motor areas.