gms | German Medical Science

70. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Skandinavischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

12.05. - 15.05.2019, Würzburg

Associations between clinical outcome and tractography based on navigated transcranial magnetic stimulation in patients with language-eloquent brain lesions

Zusammenhang zwischen klinischem Outcome und auf navigierter transkranieller Magnetstimulation basierender Traktographie bei Patienten mit spracheloquenten Hirntumoren

Meeting Abstract

  • presenting/speaker Alessia Fratini - Technische Universität München, Klinikum rechts der Isar, Neurochirurgische Klinik und Poliklinik, München, Deutschland
  • Nico Sollmann - Klinikum rechts der Isar, Technische Universität München, Neurochirurgische Klinik und Poliklinik, München, Deutschland; Klinikum rechts der Isar, Technische Universität München, Abteilung für Diagnostische und Interventionelle Neuroradiologie, München, Deutschland
  • Haosu Zhang - Technische Universität München, Klinikum rechts der Isar, Neurochirurgische Klinik und Poliklinik, München, Deutschland
  • Claus Zimmer - Klinikum rechts der Isar, Technische Universität München, Abteilung für Diagnostische und Interventionelle Neuroradiologie, München, Deutschland
  • Bernhard Meyer - Technische Universität München, Klinikum rechts der Isar, Neurochirurgische Klinik und Poliklinik, München, Deutschland
  • Sandro Krieg - Technische Universität München, Klinikum rechts der Isar, Neurochirurgische Klinik und Poliklinik, München, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 70. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Skandinavischen Gesellschaft für Neurochirurgie. Würzburg, 12.-15.05.2019. Düsseldorf: German Medical Science GMS Publishing House; 2019. DocV083

doi: 10.3205/19dgnc098, urn:nbn:de:0183-19dgnc0980

Published: May 8, 2019

© 2019 Fratini 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

Text

Objective: Navigated transcranial magnetic stimulation (nTMS) in combination with diffusion tensor imaging fiber tracking (DTI FT) is progressively used. The aim of this study is to establish nTMS-based DTI FT for preoperative risk stratification by evaluating associations between lesion-to-tract distances (LTDs) and aphasia.

Methods: Fifty patients with left-hemispheric, language-eloquent brain tumors underwent preoperative nTMS language mapping and nTMS-based DTI FT, followed by tumor resection. nTMS-based DTI FT was performed with a predefined fractional anisotropy (FA) of 0.10, 0.15, 50% of the individual FA threshold (FAT), and 75% FAT (minimum fiber length [FL]: 100 mm). The arcuate fascicle (AF), superior longitudinal fascicle (SLF), inferior longitudinal fascicle (ILF), uncinate fascicle (UC), and frontooccipital fascicle (FoF) were identified in nTMS-based tractography, and minimum LTDs were measured between the lesion and the AF and between the lesion and the closest other subcortical language-related pathway (either SLF, ILF, UC, or FoF). LTDs were then associated with the level of aphasia (no/transient or permanent surgery-related aphasia according to follow-up examinations).

Results: A significant difference in LTDs was observed between patients with no or only surgery-related transient impairment and those who developed surgery-related permanent aphasia with regards to the AF (FA=0.10: p=0.0321, FA=0.15: p=0.0143, FA=50% FAT: p=0.0106) as well as the closest other subcortical language-related pathway (FA=0.10: p=0.0182, FA=0.15: p=0.0200, FA=50% FAT: p=0.0077). Patients with surgery-related permanent aphasia showed the lowest LTDs in relation to these tracts. Thus, LTDs of ≥8 mm (AF) and ≥11 mm (either SLF, ILF, UC, or FoF) were determined as cut-off values for surgery-related permanent aphasia.

Conclusion: nTMS-based DTI FT of subcortical language-related pathways seems suitable for risk stratification and prediction in patients suffering from language-eloquent brain tumors. Thus, the current role of nTMS-based DTI FT might be expanded, going beyond the level of being a mere tool for surgical planning and resection guidance.