gms | German Medical Science

70. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Skandinavischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

12.05. - 15.05.2019, Würzburg

Corticospinal tract reconstruction based on navigated transcranial stimulation in brainstem cavernomas – Description of technique and clinical potential

Die nTMS basierte Traktografie der kortikospinalen Bahnen in Hirnstammcavernomen – Darstellung der Methodeund des klinischen Potenzials

Meeting Abstract

Suche in Medline nach

  • presenting/speaker Anna Zdunczyk - Charité – Universitätsmedizin Berlin, Klinik für Neurochirurgie, Berlin, Deutschland
  • Fabia Roth - Charité – Universitätsmedizin Berlin, Klinik für Neurochirurgie, Berlin, Deutschland
  • Thomas Picht - Charité – Universitätsmedizin Berlin, Klinik für Neurochirurgie, Berlin, Deutschland
  • Peter Vajkoczy - Charité – Universitätsmedizin Berlin, Klinik für Neurochirurgie, Berlin, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 70. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Skandinavischen Gesellschaft für Neurochirurgie. Würzburg, 12.-15.05.2019. Düsseldorf: German Medical Science GMS Publishing House; 2019. DocV308

doi: 10.3205/19dgnc326, urn:nbn:de:0183-19dgnc3265

Veröffentlicht: 8. Mai 2019

© 2019 Zdunczyk et al.
Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung). Lizenz-Angaben siehe http://creativecommons.org/licenses/by/4.0/.


Gliederung

Text

Objective: Surgical resection of brainstem cavernomas is associated with a high risk of postoperative motor deficit due to immediate vicinity of lesion and essential corticospinal tract fibers (CST) and possible affection of these by the tumor. The current study aims at establishing a reliable and objective way to visualize descending essential motor pathways with navigated TMS (nTMS) based fiber tracking.

Methods: For this pilot study 18 patients with brainstem cavernomas were examined with nTMS prior to surgery. We depicted the resting motor threshold (RMT) and recruitment curve (RC) for the FDI muscle. The cortical representation areas of hand, leg and facial function were determined. Stimulation spots were imported into the fiber tracking software and set as seed points for tractography. Next the individual FA threshold, i.e. the highest FA value leading to visualization of tracts at a predefined minimum fiber length of 110 mm, was determined. Fiber tracking was then performed at a fractional anisotropy value of 75% of the individual FA threshold.

Results: Mapping of the motor cortex and tract reconstruction for hand, leg and facial function was successful in all patients. NTMS based fiber tracking enabled detailed somatotopic tracking of corticospinal and corticonuclear tracts at the brainstem level. Higher RMT values were associated with a postoperative motor deficit (p<.05). Also, a higher RMT level correlated with a lower FA threshold (p<.05) revealing an affection of the CST. All patients developing a new postoperative deficit displayed a distance between lesion and CST of less than 2mm.

Conclusion: NTMS based fiber tracking enables objective visualization of functionally essential motor tracts surrounding brainstem cavernomas. It provides a valuable instrument for preoperative planning as well as intraoperative orientation and individual risk stratification.