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67th Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Korean Neurosurgical Society (KNS)

German Society of Neurosurgery (DGNC)

12 - 15 June 2016, Frankfurt am Main

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Metastases affecting the motor eloquent cortex should be resected with preoperative motor mapping data by nTMS

Meeting Abstract

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  • Sandro M. Krieg - Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Germany
  • Thomas Picht - Department of Neurosurgery, Charité-Universitätsmedizin Berlin, Germany
  • Mitchel S. Berger - Department of Neurological Surgery, University of California, San Francisco, CA, USA
  • Bernhard Meyer - Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Germany
  • Phiroz E. Tarapore - Department of Neurological Surgery, University of California, San Francisco, CA, USA

Deutsche Gesellschaft für Neurochirurgie. 67. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 1. Joint Meeting mit der Koreanischen Gesellschaft für Neurochirurgie (KNS). Frankfurt am Main, 12.-15.06.2016. Düsseldorf: German Medical Science GMS Publishing House; 2016. DocDI.13.03

doi: 10.3205/16dgnc175, urn:nbn:de:0183-16dgnc1758

Published: June 8, 2016

© 2016 Krieg et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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Objective: Improvement in outcome for supratentorial lesions located in motor eloquent areas, especially gliomas, was already shown repeatedly if preoperative mapping of motor areas was performed by navigated transcranial magnetic stimulation (nTMS). Yet, data on motor eloquently located metastases is still lacking. Thus, this multicentric study aimed to compare the surgical outcome of patients with motor eloquently located supratentorial metastases investigated with or without preoperative nTMS.

Method: Prospectively enrolled cohorts of our international study group were divided into patients undergoing preoperative nTMS (2010-2015; 120 patients) and patients who were operated on without nTMS data (2006-2015; 60 patients). Tumor location, size, and preoperative deficits were comparable.

Results: The nTMS group showed a lower rate of residual tumor on postoperative MRI (OR 0.2278; 95% CI 0.0.0925 – 0.0.5610). On long-term follow-up, surgery-related paresis was superior in the nTMS group (nTMS vs. non-nTMS; improved: 30.8% vs. 13.3%, unchanged: 65.8% vs. 73.3%, worse: 3.3% vs. 13.3% of patients; p=0.0.0036). Moreover, the nTMS group showed smaller craniotomies (nTMS: 16.7 ± 8.6 cm2 vs. non-nTMS: 20.0 ± 10.1 cm2; p=0.0.0395). Surgical time differed significantly between both groups (nTMS: 128.8 ± 49.4 min vs. non-nTMS: 160.1 ± 71.3 min; p=0.0.0013).

Conclusions: This work increases the level of evidence for preoperative motor mapping by nTMS for metastases affecting the motor cortex in a group comparison study. We therefore strongly advocate nTMS to become increasingly used for these lesions. However, a randomized trial on the comparison with the gold standard of intraoperative mapping seems mandatory.

Note: Sandro M. Krieg and Thomas Picht contributed equally.