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71. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
9. Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

21.06. - 24.06.2020

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Reorganisation of primary motor area in tumour patients examined by navigated transcranial magnetic stimulation (nTMS)

Die Bestimmung der Reorganisation des motorischen Areals mittels navigierter transkranieller Magnetstimulation (nTMS) bei Gliompatienten

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  • presenting/speaker Fabia Roth - Charité – Universitätsmedizin Berlin, Neurochirurgie, Berlin, Deutschland
  • Thomas Picht - Charité – Universitätsmedizin Berlin, Neurochirurgie, Berlin, Deutschland
  • Peter Vajkoczy - Charité – Universitätsmedizin Berlin, Neurochirurgie, Berlin, Deutschland
  • Anna Zdunczyk - Charité – Universitätsmedizin Berlin, Neurochirurgie, Berlin, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 71. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 9. Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie. sine loco [digital], 21.-24.06.2020. Düsseldorf: German Medical Science GMS Publishing House; 2020. DocV242

doi: 10.3205/20dgnc236, urn:nbn:de:0183-20dgnc2367

Published: June 26, 2020

© 2020 Roth 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: Patients with brain tumors in motor eloquent areas are differently affected by motor deficits due to the lesion and surgical intervention. One reason for different dynamics of disease progression and surgical outcome could be an individual potential to compensate impairments of the motor cortex. The aim of the present study was therefore to examine reorganization capacity in patients with brain tumors using navigated transcranial magnetic stimulation.

Methods: The cortical motor representation area of the first dorsal interosseous muscle was mapped on both hemispheres in 25 patients with glioma WHO ≥ II in primary and premotor cortex preoperatively and 6 months after surgery. The motor function was evaluated based on the British Medical Research Council Scale (MRC 1-5). Using nTMS the intracortical and corticospinal excitability was examined by determining the Resting Motor Threshold (RMT) and Recruitment Curve (RC). Intracortical inhibition was determined by the measurement of the Cortical Silent Period (CSP) and the cortical representation by mapping the motor area with 105% of the RMT.

Results: Mapping of the motor cortex was successful in all patients. Postoperatively 8 patients developed a new motor deficit (32%). Preoperatively, patients presented with an enlarged motor area on the affected hemisphere (AH) compared to the unaffected hemisphere (UH) (AH 430,8 mm2 vs. UH 359,3 mm2, p<.05). The preoperatively observed difference between the RMT ration of both hemispheres diminished after 6 months (preoperative 1,09 vs. follow up 0,96, p<.05). The corticospinal excitability of the affected hemisphere expressed by the RC also improved in the follow up period (AH RC slope preop 8,4 vs postop 12,5, p<.05). In trend, the cortical inhibition also decreased (preoperative AH 142,9 ms vs. follow up AH 127,1 ms, p=ns). In patients that did not recover, we observed no change in these parameters.

Conclusion: NTMS based motor mapping represents a valuable tool to measure tumor induced changes of corticospinal excitability and motor cortex reorganization. These results provide valuable information for individually tailored preoperative planning, risk stratification and postoperative follow up.