Comparison of anatomical-based vs. nTMS-based risk stratification model for predicting postoperative motor outcome and extent of resection in brain tumor surgery

Ivren, Meltem; Grittner, Ulrike; Khakhar, Rutvik; Belotti, Francesco; Schneider, Heike; Pöser, Paul; D’Agata, Federico; Spena, Giannantonio; Vajkoczy, Peter; Picht, Thomas; Rosenstock, Tizian

doi:10.1016/j.nicl.2023.103436

Cited by 3 publications

(1 citation statement)

References 36 publications

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“…Multiple studies have shown the potential of nTMS in monitoring and predicting functional recovery after functional-eloquent brain surgery [ 9 , 23 ]. Ivren et al [ 24 ] found that nTMS was able to predict the recovery of motor function in patients who underwent surgery for high-grade gliomas associated with the motor cortex (M1) or the corticospinal tract (CST). The study compared the results of nTMS with the results of clinical tests and found that nTMS was more sensitive in predicting the recovery of motor function [ 24 ].…”

Section: Discussionmentioning

confidence: 99%

Cortical–Subcortical Functional Preservation and Rehabilitation in Neuro-Oncology: Tractography-MIPS-IONM-TMS Proof-of-Concept Study

Vitulli,

Kalaitzoglou,

Soumpasis

et al. 2023

JPM

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Surgical management of deep-seated brain tumors requires precise functional navigation and minimally invasive surgery. Preoperative mapping using navigated transcranial magnetic stimulation (nTMS), intraoperative neurophysiological monitoring (IONM), and minimally invasive parafascicular surgery (MIPS) act together in a functional-sparing approach. nTMS also provides a rehabilitation tool to maximize functional recovery. This is a single-center retrospective proof-of-concept cohort study between January 2022 and June 2023 of patients admitted for surgery with motor eloquent deep-seated brain tumors. The study enrolled seven adult patients, five females and two males, with a mean age of 56.28 years old. The lesions were located in the cingulate gyrus (three patients), the central core (two patients), and the basal ganglia (two patients). All patients had preoperative motor deficits. The most common histological diagnosis was metastasis (five patients). The MIPS approach to the mid-cingulate lesions involved a trajectory through the fronto-aslant tract (FAT) and the fronto-striatal tract (FST). No positive nTMS motor responses were resected as part of the outer corridor for MIPS. Direct cortical stimulation produced stable motor-evoked potentials during the surgeries with no warning signs. Gross total resection (GTR) was achieved in three patients and near-total resection (NTR) in four patients. Post-operatively, all patients had a deterioration of motor function with no ischemia in the postoperative imaging (cavity-to-CST distance 0–4 mm). After nTMS with low-frequency stimulation in the contralateral motor cortex, six patients recovered to their preoperative functional status and one patient improved to a better functional condition. A combined Tractography-MIPS-IONM-TMS approach provides a successful functional-sparing approach to deep-seated motor eloquent tumors and a rehabilitation framework for functional recovery after surgery.

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Section: Discussionmentioning

confidence: 99%

Cortical–Subcortical Functional Preservation and Rehabilitation in Neuro-Oncology: Tractography-MIPS-IONM-TMS Proof-of-Concept Study

Vitulli,

Kalaitzoglou,

Soumpasis

et al. 2023

JPM

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Resection of meningiomas located in motor eloquent areas – comparative analysis of navigated transcranial magnetic stimulation and conventional neuronavigation

Eibl,

Schrey,

Rossmann

et al. 2024

Neurological Research

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Tumor-Specific Alterations in Motor Cortex Excitability and Tractography of the Corticospinal Tract—A Navigated Transcranial Magnetic Stimulation Study

Eibl,

Schrey,

Liebert

et al. 2024

J. Integr. Neurosci.

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Background: Non-invasive brain mapping using navigated transcranial magnetic stimulation (nTMS) is a valuable tool prior to resection of malignant brain tumors. With nTMS motor mapping, it is additionally possible to analyze the function of the motor system and to evaluate tumor-induced neuroplasticity. Distinct changes in motor cortex excitability induced by certain malignant brain tumors are a focal point of research. Methods: A retrospective single-center study was conducted involving patients with malignant brain tumors. Clinical data, resting motor threshold (rMT), and nTMS-based tractography were evaluated. The interhemispheric rMT-ratio (rMTTumor/rMTControl) was calculated for each extremity and considered pathological if it was >110% or <90%. Distances between the corticospinal tract and the tumor (lesion-to-tract-distance – LTD) were measured. Results: 49 patients were evaluated. 16 patients (32.7%) had a preoperative motor deficit. The cohort comprised 22 glioblastomas (44.9%), 5 gliomas of Classification of Tumors of the Central Nervous System (CNS WHO) grade 3 (10.2%), 6 gliomas of CNS WHO grade 2 (12.2%) and 16 cerebral metastases (32.7%). 26 (53.1%) had a pathological rMT-ratio for the upper extremity and 35 (71.4%) for the lower extremity. All patients with tumor-induced motor deficits had pathological interhemispheric rMT-ratios, and presence of tumor-induced motor deficits was associated with infiltration of the tumor to the nTMS-positive cortex (p = 0.04) and shorter LTDs (all p < 0.021). Pathological interhemispheric rMT-ratio for the upper extremity was associated with cerebral metastases, but not with gliomas (p = 0.002). Conclusions: Our study underlines the diagnostic potential of nTMS motor mapping to go beyond surgical risk stratification. Pathological alterations in motor cortex excitability can be measured with nTMS mapping. Pathological cortical excitability was more frequent in cerebral metastases than in gliomas.

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Comparison of anatomical-based vs. nTMS-based risk stratification model for predicting postoperative motor outcome and extent of resection in brain tumor surgery

Cited by 3 publications

References 36 publications

Cortical–Subcortical Functional Preservation and Rehabilitation in Neuro-Oncology: Tractography-MIPS-IONM-TMS Proof-of-Concept Study

Cortical–Subcortical Functional Preservation and Rehabilitation in Neuro-Oncology: Tractography-MIPS-IONM-TMS Proof-of-Concept Study

Resection of meningiomas located in motor eloquent areas – comparative analysis of navigated transcranial magnetic stimulation and conventional neuronavigation

Tumor-Specific Alterations in Motor Cortex Excitability and Tractography of the Corticospinal Tract—A Navigated Transcranial Magnetic Stimulation Study

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