gms | German Medical Science

72. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

06.06. - 09.06.2021

Article

Send article

Novel tractography-informed TMS language mapping protocol

Neues Traktographie-basiertes TMS Sprachkartografie-Protokoll

Meeting Abstract

Search Medline for

  • presenting/speaker Klara Reisch - Charité Universitätsmedizin, Klinik für Neurochirurgie, Berlin, Deutschland
  • Franziska Böttcher - Charité Universitätsmedizin, Klinik für Neurochirurgie, Berlin, Deutschland
  • Peter Vajkoczy - Charité Universitätsmedizin, Klinik für Neurochirurgie, Berlin, Deutschland
  • Thomas Picht - Charité Universitätsmedizin, Klinik für Neurochirurgie, Berlin, Deutschland; Humboldt Universität Berlin, Cluster of Excellence “Matters of Activity. Image Space Material”, Berlin, Deutschland
  • Lucius Fekonja - Charité Universitätsmedizin, Klinik für Neurochirurgie, Berlin, Deutschland; Humboldt Universität Berlin, Cluster of Excellence “Matters of Activity. Image Space Material”, Berlin, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 72. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgie. sine loco [digital], 06.-09.06.2021. Düsseldorf: German Medical Science GMS Publishing House; 2021. DocV230

doi: 10.3205/21dgnc221, urn:nbn:de:0183-21dgnc2213

Published: June 4, 2021

© 2021 Reisch 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 repetitive transcranial magnetic stimulation (nTMS) is used for language mapping in patients with tumors of the language system for general preoperative analyses and preoperative planning. The aim of this study was to improve the reliability and reproducibility of language nTMS mapping by using patient-specific cortical ends of language-related fiber bundles as targeted stimulation areas.

Methods: nTMS based language mapping was performed in 44 right-handed female (23) and male (21) patients, age-range 24-78 (M=53.3, SD=13.9) with left-hemispheric language-eloquent gliomas (WHO grade II (4), III (12), IV (25)) and metastases (3). The patients were further divided into two groups. Group 1 (n=22) received an earlier protocol, in which the entire perisylvian cortex was stimulated, while group 2 (n=22) received the novel tractography-based protocol, which stimulated individual cortical endings of the before delineated arcuate fascicle (AF) and peritumoral areas.

Results: nTMS and delineation of the AF was successful in all 44 patients. We observed a significant increase in error rates between group 2 (M = 5.0%, SD = 2.8%) and group 1 (M = 3.2%, SD = 2.1%), t(42) = 2.4, p = 0.02. Additionally, there was a significantly higher percentage of no response errors in group 2 (Mdn = 10%) than in group 1 (Mdn = 0%), U(NGroup 1 = 22, NGroup2 = 22) = 147, z = -2.4, p = 0.015. Our results also showed a significant difference in the distribution between nTMS-induced errors compared to non-errors using Brodmann areas (BA) X2 (25, N = 959) = 54.9, p = .001. There was a higher percentage of errors than non-errors intersecting BA 45 (errors: 9.1% vs. non-errors: 3.6%), BA 41 (errors: 4.5% vs. non-errors: 0.7%), BA 37 (errors: 4.5% vs. non-errors: 0.3%), and BA 13 (errors: 2.3% vs. non-errors: 0.0%).

Conclusion: We have demonstrated that by considering the individual anatomy and stimulation of the AF, we were able to improve the efficacy to disrupt object naming via nTMS. Thus, the newly introduced method shows promising results to obtain more reliable non-invasive personalized language maps.