Artikel
Navigated transcranial magnetic stimulation in perirolandic cerebral metastases as compared to matched high-grade gliomas: Functional outcome and impact upon the extent of resection
Suche in Medline nach
Autoren
-
Andrea Faymonville
- Department of Neurosurgery, University of Cologne, Germany
-
Catharina Schröter
- Department of Neurosurgery, University of Cologne, Germany
-
Gabriele Stoffels
- Institute of Neuroscience and Medicine, Research Center Jülich, Germany
-
Christian Grefkes
- Institute of Neuroscience and Medicine, Research Center Jülich, Germany; Department of Neurology, University of Cologne, Germany
-
Roland Goldbrunner
- Department of Neurosurgery, University of Cologne, Germany
-
Carolin Weiß Lucas
- Department of Neurosurgery, University of Cologne, Germany
| Veröffentlicht: | 8. Juni 2016 |
|---|
Gliederung
Text
Objective: In contrast to high-grade gliomas (HGG) with their infiltrative growth pattern, brain metastases (MET) are usually regarded as well delineated tumours. Surgical resection may thus be supported more often for MET in eloquent localizations than for HGG. The objective of this study was to compare the functional outcome and the rate of gross total resection (GTR) in patients harboring centrally located MET with a matched group of HGG, both groups receiving navigated transcranial magnetic stimulation (nTMS) prior to surgery.
Method: 29 patients with MET were enrolled prospectively. For matched-pair analysis, 29 patients with HGG were selected from a prospective study. Patients from both groups underwent pre-surgical nTMS mapping. The nTMS results were integrated into neuronavigation and were confirmed intraoperatively by monopolar direct cortical stimulation. Fluorescence-guidance (5-aminolevolinic acid) was used for all HGG. Motor functioning was assessed before surgery and at discharge. Postoperative changes in motor impairment were evaluated in comparison to the preoperative status. GTR was assessed by early contrast- enhanced MRI within 48 hours after surgery in all cases.
Results: Mean age of patients with MET (age: 62 ± 9 yrs) was comparable to those with HGG (age: 54 ± 13yrs). The rate of patients with preoperative motor deficits was similar for both groups (MET: 57% vs. HGG 52%). The tumor location (pre-/postcentral) was balanced for both groups (N=14/14 vs. N=13/15). In both groups, less than 15 % postoperative worsening of the motor function was observed (MET: 11% vs. HGG: 14 %) whereas more than a third of the patients improved (MET: 39 % vs. HGG: 36 %) and half remained unchanged until discharge. Rates of GTR were equal for both groups (71 %).
Conclusions: The rate of new postoperative motor deficits did not differ between MET and HGG and was within a previously published range in rolandic tumor surgery (6 – 34 %; Frey et al., 2014; Krieg et al., 2014). The improvement of preoperative functional deficit of patients with cerebral metastases as well as the rate of GTR was similar to patients of the matched HGG group. Thus, patients with perirolandic MET should be selected for surgery with the same care as HGG patients and may benefit from pre-surgical functional imaging and particularly nTMS not less than those.
