A new approach for corticospinal tract reconstruction based on navigated transcranial stimulation and standardized fractional anisotropy values

Frey, Dietmar; Strack, V.; Wiener, Edzard; Jussen, Daniel; Vajkoczy, Peter; Picht, Thomas

doi:10.1016/j.neuroimage.2012.05.059

Cited by 127 publications

(125 citation statements)

References 39 publications

(48 reference statements)

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“…This approach can improve the accuracy of diffusion tensor imaging. 5,7 6) The nTMS method is applicable also in small children; 2 on the other hand, the modalities that require a patient's voluntary movement such as fMRI sometimes cannot be performed in small children or uncooperative or disabled patients. 7) Use of nTMS enables the surgeon to assess the functional status of the motor system in patients with brain tumor.…”

Section: Discussionmentioning

confidence: 99%

“…For mapping of the motor cortex, most studies used a biphasic TMS pulse (250-280 μsec pulse length) from a figure-eight coil with an outer diameter of 70 mm applied at 110% of the resting motor threshold and a maximum frequency of 0.25 Hz. [2][3][4][5][7][8][9]12,[14][15][16][17]20,21 For lower-extremity stimulation the intensity was adapted on an individual basis.…”

Section: Literature Reviewmentioning

confidence: 99%

See 1 more Smart Citation

Navigated transcranial magnetic stimulation for mapping the motor cortex in patients with rolandic brain tumors

Takahashi¹,

Vajkoczy²,

Picht³

2013

FOC

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Object Navigated transcranial magnetic stimulation (nTMS) is a novel technology in the field of neurosurgery for noninvasive delineation of cortical functional topography. This study addresses the spatial accuracy and clinical usefulness of nTMS in brain tumor surgery in or near the motor cortex based on a systematic review of observational studies. Methods A systematic search retrieved 11 reports published up to October 2012 in which adult patients were examined with nTMS prior to surgery. Quality criteria consisted of documentation of the influence of nTMS brain mapping on clinical decision making in a standardized prospective manner and/or performance of intraoperative direct electrical stimulation (DES) and comparison with nTMS results. Cross-observational assessment of nTMS accuracy was established by calculating a weighted mean distance between nTMS and DES. Results All studies reviewed in this article concluded that nTMS correlated well with the “gold standard” of DES. The mean distance between motor cortex identified on nTMS and DES by using the mean distance in 81 patients described in 6 quantitatively evaluated studies was 6.18 mm. The nTMS results changed the surgical strategy based on anatomical imaging alone in 25.3% of all patients, based on the data obtained in 87 patients in 2 studies. Conclusions The nTMS technique spatially correlates well with the gold standard of DES. Its functional information benefits surgical decision making and changes the treatment strategy in one-fourth of cases.

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Section: Discussionmentioning

confidence: 99%

Section: Literature Reviewmentioning

confidence: 99%

Navigated transcranial magnetic stimulation for mapping the motor cortex in patients with rolandic brain tumors

Takahashi¹,

Vajkoczy²,

Picht³

2013

FOC

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“…Thus, preoperative visualization by diffusion tensor imaging fiber tracking (DTI FT) and intraoperative subcortical stimulation mapping are therefore increasingly used and have already been proven to correlate sufficiently (Bello et al 2008;Leclercq et al 2010;Vassal et al 2013). Mapping of cortical motor areas by nTMS was recently found to be useful for nTMS-based DTI FT of the corticospinal tract (CST; (Frey et al 2012;Krieg et al 2012a;Conti et al 2014). These studies showed good and reliable results for nTMS, leading to a higher standardization of DTI FT of the motor system.…”

Section: Introductionmentioning

confidence: 99%

“…Thus, these previous data raise the question of whether language-related cortical areas identified via repetitive nTMS (rTMS) can also be used as seed regions for rTMSbased DTI FT for the visualization of subcortical language tracts in order to also provide visualization of subcortical language structures prior to neurosurgical procedures or for general neuroscientific research applications (Frey et al 2012;Krieg et al 2012a;Conti et al 2014).…”

Section: Introductionmentioning

confidence: 99%

Visualization of subcortical language pathways by diffusion tensor imaging fiber tracking based on rTMS language mapping

Negwer

Ille

Hauck

et al. 2016

Brain Imaging and Behavior

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Diffusion tensor imaging fiber tracking (DTI FT) is used to visualize subcortical fiber tracts. Yet, there is no standard at hand to visualize language-involved subcortical fibers reliably. Thus, this study investigates the feasibility of using language-related cortical areas identified via repetitive navigated transcranial magnetic stimulation (rTMS) to seed DTI FT of subcortical language tracts. From 2011 to 2014, 37 patients with left-hemispheric perisylvian lesions were examined. Language-positive rTMS stimulation spots were integrated in the deterministic tractography software (BrainLAB, iPlanNet 3.0) as objects and used as seed regions for DTI FT. Tractography was then performed in each patient with 77 different combinations of fiber lengths (40 - 100 mm) and fractional anisotropy (FA; 0.01 - 0.5). The rTMS-based DTI FT identified all commonly known subcortical language tracts, such as the corticonuclear tract, arcuate fascicle, uncinate fascicle, superior longitudinal fascicle, inferior longitudinal fascicle, arcuate fibers, commissural fibers, corticothalamic fibers, and the fronto-occipital fascicle. In 32 patients (86.5 %), each above-named tract could be visualized, while at least 6 out of these 9 tracts were identified in each patient. A fiber length of 100 mm and an FA of 0.1 or 0.15 provided optimal visualization by revealing 125 and 61 individually tracked fibers per visualized language tract and 90 % and 73 % of all language-related tracts, respectively. This study proves the feasibility of rTMS-based DTI FT for subcortical language tracts, provides suitable settings, and shows its easy and standardizable application for the visualization of every language tract in 86.5 % of patients.

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“…To accurately map corticospinal pathways from peri-lesional cortex, several techniques are available for humans, including TMS, or epidural or cortical stimulation [65], and an MRI method called diffusion tensor imaging (DTI) [66]. TMS is becoming a noninvasive proxy for invasive cortical stimulation in functional neurosurgery [63], while DTI is gaining popularity to view cortical terminals of corticospinal tracts [66,67]. In future studies, TMS and DTI could complement fMRI in identifying eloquent cortices that also project most functioning corticospinal pathways, a feat being explored in our preliminary work [68].…”

Section: Methodological: Localizing To Substrates and Determining Funmentioning

confidence: 99%

Invasive Neurostimulation in Stroke Rehabilitation

Plow

Machado

2014

Neurotherapeutics

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The last decade has seen a growing interest in adjuvant treatments that synergistically influence mechanisms underlying rehabilitation of paretic upper limb in stroke. One such approach is invasive neurostimulation of spared cortices at the periphery of a lesion. Studies in animals have shown that during training of paretic limb, adjuvant stimulation targeting the peri-infarct circuitry enhances mechanisms of its reorganization, generating functional advantage. Success of early animal studies and clinical reports, however, failed to translate to a phase III clinical trial. As lesions in humans are diffuse, unlike many animal models, peri-infarct circuitry may not be a feasible, or consistent target across most. Instead, alternate mechanisms, such as changing transcallosal inhibition between hemispheres, or reorganization of other viable regions in motor control, may hold greater potential. Here, we review comprehensive mechanisms of clinical recovery and factors that govern which mechanism(s) become operative when. We suggest novel approaches that take into account a patient's initial clinical-functional state, and findings from neuroimaging and neurophysiology to guide to their most suitable mechanism for ideal targeting. Further, we suggest new localization schemes, and bypass strategies that indirectly target peri-lesional circuitry, and methods that serve to counter technical and theoretical challenge in identifying and stimulating such targets at the periphery of infarcts in humans. Last, we describe how stimulation may modulate mechanisms differentially across varying phases of recovery-a temporal effect that may explain missed advantage in clinical trials and help plan for the next stage. With information presented here, future trials would effectively be able to target patient's specific mechanism(s) with invasive (or noninvasive) neurostimulation for the greatest, most consistent benefit. [2], which remains one of the most important predictors of disability and poor quality of life [3]. Disability adds to the costs of disease management that total $74 billion/ year [4]. Developing methods to effectively alleviate residual deficits will reduce health and economic burden of stroke.Several evidence-based rehabilitative approaches have been developed with prominent ones, including neuromuscular electrical stimulation [5], motor learning [6], robotic training [7] constraint-induced movement therapy [8], and bilateral arm training [9], etc. In spite of extensive therapy, recovery is frequently incomplete [10]. There is a critical need for adjuvant strategies that augment rehabilitative outcomes of paretic hand.The last decade has seen a growing interest in the promise of adjuvant treatments that synergistically influence mechanisms associated with rehabilitation. One such approach is invasive neuromodulation, involving electrical stimulation applied to cortical or subcortical targets spared by stroke. By directly stimulating viable targets, it is believed that potential for plasticity underlying reh...

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A new approach for corticospinal tract reconstruction based on navigated transcranial stimulation and standardized fractional anisotropy values

Cited by 127 publications

References 39 publications

Navigated transcranial magnetic stimulation for mapping the motor cortex in patients with rolandic brain tumors

Navigated transcranial magnetic stimulation for mapping the motor cortex in patients with rolandic brain tumors

Visualization of subcortical language pathways by diffusion tensor imaging fiber tracking based on rTMS language mapping

Invasive Neurostimulation in Stroke Rehabilitation

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