gms | German Medical Science

63rd Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Japanese Neurosurgical Society (JNS)

German Society of Neurosurgery (DGNC)

13 - 16 June 2012, Leipzig

Test-retest reliability of primary motor cortex mapping: Neuronavigated transcranial magnetic brain stimulation (nTMS) versus functional MRI (fMRI)

Meeting Abstract

  • C. Weiss - Klinik für Allgemeine Neurochirurgie, Universitätsklinikum Köln; Max-Planck-Institut für Neurologische Forschung, Köln
  • V. Neuschmelting - Klinik für Allgemeine Neurochirurgie, Universitätsklinikum Köln
  • A. Eisenbeis - Klinik für Allgemeine Neurochirurgie, Universitätsklinikum Köln
  • C. Nettekoven - Max-Planck-Institut für Neurologische Forschung, Köln
  • A.K. Rehme - Max-Planck-Institut für Neurologische Forschung, Köln
  • C. Grefkes - Klinik und Poliklinik für Neurologie, Universitätsklinikum Köln; Max-Planck-Institut für Neurologische Forschung, Köln
  • R. Goldbrunner - Klinik für Allgemeine Neurochirurgie, Universitätsklinikum Köln

Deutsche Gesellschaft für Neurochirurgie. Japanische Gesellschaft für Neurochirurgie. 63. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie (JNS). Leipzig, 13.-16.06.2012. Düsseldorf: German Medical Science GMS Publishing House; 2012. DocDO.16.08

doi: 10.3205/12dgnc151, urn:nbn:de:0183-12dgnc1514

Published: June 4, 2012

© 2012 Weiss et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



Objective: Presurgical functional brain mapping is essential for optimized resection planning of eloquently located brain tumors. Functional magnetic resonance imaging (fMRI) has been the most established method for presurgical motor mapping but was shown to have a rather low test-retest reliability, especially for the face and the tongue area. Recently, neuronavigated Transcranial Magnetic Stimulation (nTMS) has attracted rising attention as an alternative motor mapping method applicable for clinical routine. Anyway, little was known about the reliability of nTMS. Thus, we compared the reliability of both motor mapping approaches in a preclinical trial.

Methods: We examined 10 healthy, right-handed subjects on three days (d0, d3–5, week 3–5) by nTMS (eXimia 3.2.2, 110% of resting motor threshold on dominant primary motor cortex, MEP recordings: abductor pollicis brevis muscle, plantaris muscle, perioral muscles, tongue) and fMRI (Siemens 3T Trio, motor paradigms: [1] bilateral thumb abduction, [2] unilateral toe flexion, [3] pursing lips, [4] tongue abduction). Euclidean distances (ED) between hotspots and centers of gravity (CoG) of the three mapping sessions were calculated. Spatial reliability was tested by intersession overlaps and voxel-wise interclass correlation (ICC).

Results: Overall, the mean ED of the hotspots was higher for nTMS (10.77 ± 1.88 mm) as compared to fMRI (6.2 ± 1.1 mm), whereas there was no difference in ED of the CoGs (mean 6.7 mm). Regarding the spatial reliability (i.e., overlap volumes and ICC), nTMS was superior for hand and foot mappings but not for perioral and tongue mappings. The cortical representation of the perioral showed a broad overlap with the tongue area in both assessments.

Conclusions: CoGs were similarly reproducible by fMRI and nTMS. Both methods seem sufficiently reliable for clinical application. In terms of spatial reliability, nTMS seems to be superior to map the primary motor areas of hand and foot but less accurate for lips and tongue. Thus, both methods may well complement each other in the clinical routine.