gms | German Medical Science

68th Annual Meeting of the German Society of Neurosurgery (DGNC)
7th Joint Meeting with the British Neurosurgical Society (SBNS)

German Society of Neurosurgery (DGNC)

14 - 17 May 2017, Magdeburg

Preoperative navigated transcranial magnetic stimulation and tractography in transparietal approach to the trigone of the lateral ventricle

Meeting Abstract

  • Philipp Hendrix - Klinik für Neurochirurgie, Universitätsklinik des Saarlandes, Homburg/Saar, Germany, Homburg/Saar, Deutschland
  • Sebastian Senger - Homburg/Saar, Deutschland
  • Christoph J. Griessenauer - Department of Neurosurgery, Geisinger Health System, Danville, PA, Danville, United States
  • Andreas Simgen - Department of Neuroradiology, Saarland University Medical Center and Saarland University Faculty of Medicine, Homburg/Saar, Germany, Homburg/Saar, Deutschland
  • Stefan Linsler - Klinik für Neurochirurgie, Universitätsklinik des Saarlandes, Homburg/Saar, Germany, Homburg/Saar, Deutschland
  • Joachim Oertel - Homburg/Saar, Deutschland

Deutsche Gesellschaft für Neurochirurgie. Society of British Neurological Surgeons. 68. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 7. Joint Meeting mit der Society of British Neurological Surgeons (SBNS). Magdeburg, 14.-17.05.2017. Düsseldorf: German Medical Science GMS Publishing House; 2017. DocMi.23.07

doi: 10.3205/17dgnc527, urn:nbn:de:0183-17dgnc5270

Published: June 9, 2017

© 2017 Hendrix et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at



Objective: Eloquent neural structures surround the trigone of the lateral ventricle. Therefore, surgical procedures in the vicinity of the trigone challenge the surgeon. Depending on tumor entity, size, location and extension, and size of the ventricles, various surgical approaches have been proposed. The transparietal approach is one established surgical corridor. Preoperative workup via tractography and nTMS mapping may facilitate identification of the optimal surgical route in the transparietal approach to the trigone.

Methods: The authors retrospectively reviewed all patients with trigonal tumors that underwent combined preoperative nTMS motor mapping, preoperative rTMS language mapping, nTMS-based corticospinal tract tractography, and optic radiation tractography for presurgical workup.

Results: Five patients underwent this combined workup. Preoperatively, the information supported fast and accurate selection of an optimal trajectory for a transparietal approach towards the trigone. Eventually, four patients underwent surgical resection guided by intraoperative a multimodal neuronavigation containing nTMS and tractography data. None of the four patients experienced a new permanent deficit.

Conclusion: Combination of preoperative nTMS and tractography facilitates the identification of the optimal parietal trajectory towards the trigone. Specifically, it allows for sparing of visual pathways as well as cortical language areas.