gms | German Medical Science

68th Annual Meeting of the German Society of Neurosurgery (DGNC)
7th Joint Meeting with the British Neurosurgical Society (SBNS)

German Society of Neurosurgery (DGNC)

14 - 17 May 2017, Magdeburg

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Preoperative rTMS language mapping in speech eloquent brain lesions: a matched cohort study

Meeting Abstract

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  • Philipp Hendrix - Klinik für Neurochirurgie, Universitätsklinik des Saarlandes, Homburg/Saar, Germany, Homburg/Saar, Deutschland
  • Sebastian Senger - Klinik für Neurochirurgie, Universitätsklinik des Saarlandes, Homburg/Saar, Germany, Homburg/Saar, Deutschland
  • Andreas Simgen - Department of Neuroradiology, Saarland University Medical Center and Saarland University Faculty of Medicine, Homburg/Saar, Germany, Homburg/Saar, Deutschland
  • Christoph J. Griessenauer - Department of Neurosurgery, Geisinger Health System, Danville, PA, Danville, United States
  • Joachim Oertel - Klinik für Neurochirurgie, Universitätsklinik des Saarlandes, Homburg/Saar, Germany, Homburg/Saar, Deutschland

Deutsche Gesellschaft für Neurochirurgie. Society of British Neurological Surgeons. 68. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 7. Joint Meeting mit der Society of British Neurological Surgeons (SBNS). Magdeburg, 14.-17.05.2017. Düsseldorf: German Medical Science GMS Publishing House; 2017. DocMi.09.08

doi: 10.3205/17dgnc427, urn:nbn:de:0183-17dgnc4275

Published: June 9, 2017

© 2017 Hendrix 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: Repetitive language mapping is an evolving noninvasive modality to map cortical language distribution. The value of preoperative rTMS language mapping for function preservation in surgery of speech eloquent lesions under general anesthesia remains to be determined.

Methods: To analyze value of rTMS language implementation in the preoperative routine, the authors performed a matched-pair study. Prospectively, 20 consecutive right-handed patients with a malignant, left-sided perisylvian language eloquent brain tumor were enclosed. All patients were subjected to surgical resection under general anesthesia guided by preoperative rTMS language mapping (rTMS group, 2014 – 2016). Matching was performed with 20 patients that underwent surgical resection in the pre-rTMS era (pre-rTMS group, 2009 – 2013). The patients´ language performance status was ranked from grade 0 to grade 3 (none, mild, medium, severe).

Results: Comparison of rTMS vs pre-rTMS groups revealed equal rates of gross total resection, of tumor residual, and of complications. Required time for the entire surgical procedure was significantly shorter in the rTMS group (p = 0.039). Preoperatively, 14/20 patients in the rTMS and 13/20 patients in the pre-rTMS group suffered from language deficits (p = 0.380). One week after surgery, 8/14 patients (57.1 %) in the rTMS group but only 1/13 patients (7.7 %) in the pre-rTMS group experienced improvement of language performance status (p = 0.013). Moreover, at six weeks follow-up in the outpatient clinic, language performance status was significantly better in the rTMS group (p = 0.048).

Conclusion: Preoperative rTMS language mapping has the potential to provide beneficial functional outcomes, particularly in the early postoperative phase. Therefore, preoperative rTMS language mapping is a valuable tool for the resection of language eloquent lesions under general anesthesia.