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73. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Griechischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

29.05. - 01.06.2022, Köln

Preoperative diagnostics of insular gliomas by navigated Transcranial Magnetic Stimulation (nTMS) and DTI-Tractography

Präoperative Diagnostik mittels Navigierter Transkranieller Magnetstimulation und DTI-Traktographie bei Patienten mit Inselgliomen

Meeting Abstract

Suche in Medline nach

  • presenting/speaker Maren Denker - Charité – Universitätsmedizin Berlin, Klinik für Neurochirurgie, Berlin, Deutschland
  • Thomas Picht - Charité – Universitätsmedizin Berlin, Klinik für Neurochirurgie, Berlin, Deutschland
  • Anna Zdunczyk - Charité – Universitätsmedizin Berlin, Klinik für Neurochirurgie, Berlin, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 73. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Griechischen Gesellschaft für Neurochirurgie. Köln, 29.05.-01.06.2022. Düsseldorf: German Medical Science GMS Publishing House; 2022. DocV246

doi: 10.3205/22dgnc238, urn:nbn:de:0183-22dgnc2386

Veröffentlicht: 25. Mai 2022

© 2022 Denker 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: The operative resection of insular gliomas poses a risk of permanent hemiparesis and aphasia of up to 10%. Through navigated transcranial magnetic stimulation (nTMS) and nTMS-based DTI-tractography motor eloquent brain areas can be identified, and the motoric tracts visualized preoperatively. The aim of the study was to evaluate to what extent neurophysiological nTMS-parameters and diffusion parameters, such as the fractional anisotropy (FA) and apparent diffusion coefficient (ADC), can be used preoperatively to assess the risk of postoperative motoric deficits (PMD).

Methods: We conducted a retrospective data analysis of 20 patients who underwent a bihemispheric nTMS-examination preoperatively and had a complete record of their pre- and postoperative motor status. A nTMS-based DTI-tractography was performed to extract the average and peritumoral values of the diffusion parameters FA and ADC as well as assess the distance between the tumour and the corticospinal-tract (CST).

Results: The distance between the tumour and CST ≤ 1mm was identified as critical as it was associated with a new PMD (p = 0,007). A tumour-CST-distance of ≤ 3mm altered the peritumoral FA (pFA) and ADC (pADC) values (p = 0,045 resp. p = 0,024) and the interhemispheric pFA and pADC ratio showed an association with a PMD (p = 0,017 resp. p = 0,012). Furthermore, the interhemispheric pFA ratio could predict the postoperative motor status (RR = 0,205; p = 0,049).

Conclusion: These findings offer a relevant benefit for perioperative risk stratification, operative planning and intraoperative neuromonitoring in patients with insular gliomas.

Figure 1 [Fig. 1], Figure 2 [Fig. 2]