Article
Preoperative rTMS language mapping for the resection of speech eloquent brain lesions under general anesthesia: a single center series in 60 patients
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Authors
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Philipp Hendrix
- Geisinger Health System, Department of Neurosurgery, Danville, PA, Vereinigte Staaten
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Luciano Furlanetti
- Universitätsklinikum des Saarlandes, Klinik für Neurochirurgie, Homburg, Deutschland
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Sebastian Senger
- Universitätsklinikum des Saarlandes, Klinik für Neurochirurgie, Homburg, Deutschland
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Christoph J. Griessenauer
- Geisinger Health System, Department of Neurosurgery, Danville, PA, Vereinigte Staaten
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Andreas Simgen
- Geisinger Health System, Department of Neurosurgery, Danville, PA, Vereinigte Staaten; Universitätsklinikum des Saarlandes, Institut für Neuroradiologie, Homburg, Deutschland
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Joachim Oertel
- Universitätsklinikum des Saarlandes, Klinik für Neurochirurgie, Homburg, Deutschland
| Published: | June 18, 2018 |
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Outline
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Objective: Repetitive transcranial magnetic stimulation (rTMS) allows for non-invasive mapping of positive and negative cortical language sites. It has been used to preoperatively assess language function in patients suffering from language eloquent brain lesions. The value of preoperative rTMS language mapping still requires further exploration.
Methods: Consecutive patients that underwent preoperative rTMS language mapping between January 2014 and October 2017 were evaluated. Surgical, imaging and functional data was prospectively recorded. All patients suffering from language eloquent brain lesions that underwent surgery under general anesthesia supported by the preoperatively acquired rTMS language map were eligible for the herein presented analysis. The preoperative rTMS language map was used for intraoperative neuronavigation.
Results: Collectively, 60 patients underwent rTMS-supported surgery under general anesthesia. Patients suffered from cerebral metastasis (17), glioblastoma (23), low-grade glioma (8), cavernous malformation (5), AVM (3), high-grade glioma WHO III (2), DNET (1) and astroblastoma (1). A left-sided lesion was present in 57/60 of the cases (95%). In 3/60 of the cases (5%), patients suffered from right-sided lesions, were left-handed and presented speech disturbances preoperatively. In total, 43 of all patients (71.7%) had preoperative language deficits. After surgery, language function deteriorated in 4 out of 43 patients (9.3%). A new language deficit occurred in 2 out of 17 patients (11.8%). Postoperatively, in 28 out of 43 patients (65.1%) language performance improved within the first week. After two months, 80% of the patients experienced additional language improvement. Finally, 86.3% of the cohort had regular language function at two-months follow-up.
Conclusion: Preoperative rTMS language mapping likely contributes to a favorable language outcome in patients undergoing resection of language eloquent lesions under general anesthesia. Further research is required to substantiate these findings.
