Article
Functional intraoperative Navigation using preoperative TMS and direct intraoperative Stimulation of the Motor Cortex in Patients with Brain Tumors in the Vicinity of the Central Region
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Authors
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Katja Jähne
- Universitätsklinikum Leipzig AöR, Klinik und Poliklinik für Neurochirurgie, Leipzig, Deutschland
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Katharina Köhlert
- Universitätsklinikum Leipzig AöR, Klinik und Poliklinik für Neurochirurgie, Leipzig, Deutschland
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Jürgen Meixensberger
- Universität Leipzig AöR, Universitätsklinikum Leipzig, Klinik und Poliklinik für Neurochirurgie, Leipzig, Deutschland
| Published: | June 9, 2017 |
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Outline
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Objective: Feasibility and value of non-invasive transcranial magnetic brain stimulation (TMS MagVenture MagPro R30 Denmark), for preoperative diagnosis and surgical planning in everyday clinical practice
Methods: A prospective study was conducted, which included preoperative a neurological and electrophysiological examination, TMS and display of functional data in the navigation (Localite TMS Navigator Germany). Before surgery TMS data were presented in our neuroimaging board. During surgery the TMS data were correlated with the intraoperative monitoring (IOM). Between 24h-96h and after 3 months a neurological, electrophysiological examination and an additional TMS stimulation were performed.
Results: A total of 26 patients with tumors in or near by the motor cortex region were included in the study. 8 out of 26 patients were diagnosed with glioblastoma, 3 with meningioma, 12 with metastases and 3 with lymphoma. We did not include patients with preoperative epileptic seizures. 22 patients could complete both preoperative and the first postoperative TMS. The 4 excluded patients suffered a pulmonary embolism, a postoperative seizure, a swelling of the larynx or it led to claustrophobia in the MRI. Preoperative TMS data influenced surgeons’ decision in planning operative approach and resection strategy. In first postoperative control 7 out of 22 stimulated patients showed slight worsening of motor cortex function, 10 patients had an unchanged state and 5 patients showed an improvement immediately after surgery. A correspondence between the intraoperative findings (IOM, TMS), postoperative diagnosis and postoperative electrophysiological examination could be found. The changes of the electrophysiological examination completely matched with the postoperative neurological outcome. So if patients showed a change in the SEP`s, the postoperative results revealed new occurrences of deterioration. A preserved continuity of SEP`s showed an improvement of the clinical outcome.
Conclusion: TMS allows a safe and reliable representation of the primary motor cortex both preoperatively and intraoperatively. In summary the combination of preoperative TMS and intraoperative SEP`s contribute to an improvement of the representability of the motor cortex, thereby reduced surgical scope and finally the enhanced clinical outcome.
