gms | German Medical Science

65th Annual Meeting of the German Society of Neurosurgery (DGNC)

German Society of Neurosurgery (DGNC)

11 - 14 May 2014, Dresden

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Navigated transcranial magnetic stimulation improves the treatment outcome in patients with tumors in presumed motor eloquent location

Meeting Abstract

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  • Dietmar Frey - Neurochirurgische Klinik, Charité – Universitätsmedizin Berlin
  • Sarah Schilt - Neurochirurgische Klinik, Charité – Universitätsmedizin Berlin
  • Valérie Strack - Neurochirurgische Klinik, Charité – Universitätsmedizin Berlin
  • Anna Zdunczyk - Neurochirurgische Klinik, Charité – Universitätsmedizin Berlin
  • Judith Rösler - Neurochirurgische Klinik, Charité – Universitätsmedizin Berlin
  • Birat Niraula - Neurochirurgische Klinik, Charité – Universitätsmedizin Berlin
  • Heike Schneider - Neurochirurgische Klinik, Charité – Universitätsmedizin Berlin
  • Peter Vajkoczy - Neurochirurgische Klinik, Charité – Universitätsmedizin Berlin
  • Thomas Picht - Neurochirurgische Klinik, Charité – Universitätsmedizin Berlin

Deutsche Gesellschaft für Neurochirurgie. 65. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC). Dresden, 11.-14.05.2014. Düsseldorf: German Medical Science GMS Publishing House; 2014. DocMI.19.01

doi: 10.3205/14dgnc387, urn:nbn:de:0183-14dgnc3879

Published: May 13, 2014

© 2014 Frey 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 transcranial magnetic stimulation (nTMS) enables delineation of resectable versus non-resectable cortical tissue in motor areas. This study examines the treatment of centrally located tumours during two consecutive periods in the same department –the first without and the second with the use of nTMS.

Method: To study the impact of nTMS on the treatment we examined 250 consecutive patients and compared the functional and oncological outcome to a matched pre-TMS control group (n = 115).

Results: nTMS depiction of the primary motor cortex was in accordance with the intraoperative stimulation brain mapping (ISM) in all cases. The nTMS mapping results falsified the suspected involvement of the primary motor cortex in 21.5% of the cases and led to the planning of a more extensive resection in 35.2% and to a more restrictive resection in 3.5% of the cases. In comparison to the control group the addition of nTMS led to a reduction of postoperative deficits from 9.5% to 7.5% and to an increased rate of gross total resections from 78% to 95%. The progression free survival for low-grade/malignant glioma was significantly better in the nTMS group with 28.5/15.5 month than in the control group with 15.4/12.4 months.

Conclusions: nTMS enables more extensive resection of tumours involving essential motor areas and leads to improved neurological outcome and prolonged progression free survival.