Artikel
Preoperative nTMS motor mapping for the resection of motor eloquent brain lesions: a single center series in 100 patients
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Autoren
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Philipp Hendrix
- Universitätsklinikum des Saarlandes, Institut für Neuroradiologie, Homburg, Deutschland
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Luciano Furlanetti
- Universitätsklinikum des Saarlandes, Klinik für Neurochirurgie, Homburg, Deutschland
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Sebastian Senger
- Universitätsklinikum des Saarlandes, Klinik für Neurochirurgie, Homburg, Deutschland
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Christoph J. Griessenauer
- Geisinger Health System, Department of Neurosurgery, Danville, PA, Vereinigte Staaten
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Andreas Simgen
- Geisinger Health System, Department of Neurosurgery, Danville, PA, Vereinigte Staaten; Universitätsklinikum des Saarlandes, Institut für Neuroradiologie, Homburg, Deutschland
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Joachim Oertel
- Universitätsklinikum des Saarlandes, Klinik für Neurochirurgie, Homburg, Deutschland
| Veröffentlicht: | 18. Juni 2018 |
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Gliederung
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Objective: Preoperative navigated transcranial magnetic stimulation (nTMS) is an established non-invasive method to map the motor cortex. To date, there are few larger cohorts demonstrating the beneficial value of nTMS supported resection of motor eloquent lesions. Here, we seek to extend the current evidence of preoperative nTMS application for motor eloquent brain lesions.
Methods: Consecutive patients that underwent preoperative nTMS motor mapping between June 2013 and September 2017 were evaluated. Surgical, imaging and functional data was prospectively recorded. All patients suffering from motor eloquent brain lesions that underwent surgery supported by the preoperatively acquired nTMS motor map were eligible for the herein presented analysis. The preoperative nTMS motor map was used for intraoperative neuronavigation.
Results: Collectively, 100 patients underwent nTMS-supported surgery. Patients suffered from cerebral metastasis (39), glioblastoma (27), meningioma (13), low-grade glioma (6), high-grade glioma WHO III (5), cavernous malformation (4), lymphoma (2), AVM (2), DNET (1) and astroblastoma (1). Preoperatively, 52/100 patients (52%) presented a motor deficit. Motor function improved in 14/52 of the patients (26.9%) and completely recovered in 13/52 of the patients (25.0%) within the first postoperative week. Motor function remained unaltered in 20/52 of the patients (38.5%) and deteriorated in 5/52 of the patients (9.6%). Follow-up motor examination was available in 23/39 of the postoperative paretic patients (59.0%)). After two months, 18/23 of those patients (78.3%) experienced additional motor function recovery. A new motor deficit occurred in 8/42 of patients (19.0%) without presurgical motor deficit. At two month follow-up, in 7/8 of those patients (87.5%) motor function improved. A persistent motor deficit was present in 4/42 of the patients (9.5%).
Conclusion: Preoperatively acquired nTMS motor maps support surgical treatment of motor eloquent brain lesions. A favorable neurological outcome is achievable in both patients with and without a priorly existing motor deficit.
