gms | German Medical Science

66th Annual Meeting of the German Society of Neurosurgery (DGNC)
Friendship Meeting with the Italian Society of Neurosurgery (SINch)

German Society of Neurosurgery (DGNC)

7 - 10 June 2015, Karlsruhe

Article

Send article

Preoperative repetitive navigated transcranial magnetic stimulation for language mapping and outcome improvement in brain tumor patients

Meeting Abstract

Search Medline for

  • Nico Sollmann - Neurochirurgische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München
  • Theresa Hauck - Neurochirurgische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München
  • Sebastian Ille - Neurochirurgische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München
  • Bernhard Meyer - Neurochirurgische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München
  • Florian Ringel - Neurochirurgische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München
  • Sandro M. Krieg - Neurochirurgische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München

Deutsche Gesellschaft für Neurochirurgie. 66. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC). Karlsruhe, 07.-10.06.2015. Düsseldorf: German Medical Science GMS Publishing House; 2015. DocP 112

doi: 10.3205/15dgnc510, urn:nbn:de:0183-15dgnc5104

Published: June 2, 2015

© 2015 Sollmann et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

Text

Objective: Language mapping by repetitive navigated transcranial magnetic stimulation (rTMS) is used for resection planning in patients suffering from brain lesions within regions known to be involved in language function. Yet, we also need data that show whether preoperative rTMS for language mapping also has an impact on the patients' clinical course and functional outcomes as it was proved for motor mapping.

Method: We enrolled 25 patients with language eloquently located brain lesions undergoing preoperative rTMS language mapping (GROUP 1, 2011-2013) with mapping results not being available for the surgeon, and matched these patients with 25 subjects, who also underwent preoperative rTMS (GROUP 2, 2013-2014), but mapping results were taken into account during awake mapping and tumor resection via implementation into the neuronavigation system. In addition, cortical language maps were generated by analyzing preoperative rTMS data.

Results: Mean craniotomy sizes were significantly smaller in patients of GROUP 2 (GROUP 1 vs. GROUP 2: 50.1 ± 16.8 cm2 vs. 41.6 ± 10.4 cm2, p=0.0373), and postoperative language deficits were found significantly more often in patients of GROUP 1 (p=0.0153), although preoperative language status did not differ between groups (p=0.7576). In addition, there was a trend towards less unexpected tumor residuals (GROUP 1 vs. GROUP 2: 32.0% vs. 16.0%, p=0.1853), shorter surgery duration (240.3 ± 53.2 min. vs. 215.5 ± 48.5 min., p=0.0914), and higher postoperative KPS scores (80 vs. 90, p=0.2102) in GROUP 2 patients.

Conclusions: In general, the clinical course and functional outcomes of patients suffering from brain tumors may be improved by preoperative rTMS language mapping. Furthermore, reliable and precise language maps can be generated by rTMS in brain tumor patients, and this approach has once again proven to be safe, effective, and well-tolerable for the individual subject. However, more patients have to be enrolled for more conclusive data.