Functional Reconstruction of Motor and Language Pathways Based on Navigated Transcranial Magnetic Stimulation and DTI Fiber Tracking for the Preoperative Planning of Low Grade Glioma Surgery: A New Tool for Preservation and Restoration of Eloquent Networks

Raffa, Giovanni; Conti, Alfredo; Scibilia, Antonino; Sindorio, Carmela; Quattropani, Maria C.; Visocchi, Massimiliano; Germanò, Antonino; Tomasello, Francesco

doi:10.1007/978-3-319-39546-3_37

Cited by 52 publications

(46 citation statements)

References 13 publications

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“…In addition, the nTMS-based DTI-FT of the CST is able to use during surgery as a guide for orienting DES and lesion resection. Recent study showed that nTMS mapping especially nTMS-based DTI-FT can be served as a suitable surgical technique for motor-eloquent lesions and is likely to promote the risk/benefit analysis, resection extent, and outcomes [48][49][50].…”

Section: Ntms and Fmrimentioning

confidence: 99%

Current status and potential application of navigated transcranial magnetic stimulation in neurosurgery: a literature review

Fang

Liu

et al. 2019

Chin Neurosurg Jl

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Transcranial magnetic stimulation (TMS) is a noninvasive neurophysiologic technique that can stimulate the human brain. Positioning of the coil was often performed based merely on external landmarks on the head, meaning that the anatomical target in the cortex remains inaccurate. Navigated transcranial magnetic stimulation (nTMS) combines a frameless stereotactic navigational system and TMS coil and can provide a highly accurate delivery of TMS pulses with the guidance of imaging. Therefore, many novel utilities for TMS could be explored due to the ability of precise localization. Many studies have been published, which indicate nTMS enables presurgical functional mapping. This review aimed to provide a comprehensive literature review on nTMS, especially the principles and clinical applications of nTMS. All articles in PubMed with keywords of "motor mapping," "presurgical mapping," "navigated transcranial magnetic stimulation," and "language mapping" published from 2000 to 2018 were included in the study. Frequently cited publications before 2000 were also included. The most valuable published original and review articles related to our objective were selected. Motor mapping of nTMS is validated to be a trustful tool to recognize functional areas belonging to both normal and lesioned primary motor cortex. It can offer reliable mapping of speech and motor regions at cortex prior to operation and has comparable accuracy as direct electrical cortical stimulation. nTMS is a powerful tool for mapping of motor and linguistic function prior to operation, has high application value in neurosurgery and the treatment of neurological and psychiatric diseases, and has gained increasing acceptance in neurosurgical centers across the world.

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Section: Ntms and Fmrimentioning

confidence: 99%

Current status and potential application of navigated transcranial magnetic stimulation in neurosurgery: a literature review

Fang

Liu

et al. 2019

Chin Neurosurg Jl

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“…In contrast to functional MRI, diffusion MR images can be acquired without the need for cooperation, and therefore even in sedated or sleeping children; this makes dMRI a potentially more broadly applicable technique in the clinical setting (albeit bearing in mind the potential risks of repeated anesthesia in young children). Common applications of diffusion MRI in the language domain include assessing the arcuate fasciculus and other white matter language‐associated tracts . In the sensorimotor domain, the most relevant question will usually entail the visualization of the corticospinal tract .…”

Section: Preconditionsmentioning

confidence: 99%

“…Common applications of diffusion MRI in the language domain include assessing the arcuate fasciculus and other white matter language‐associated tracts . In the sensorimotor domain, the most relevant question will usually entail the visualization of the corticospinal tract . In the visual domain, recent methodological advances now also allow for the delineation of such complex white matter structures as the Meyer loop, in addition to the more prominent posterior parts of the optic radiation …”

Section: Preconditionsmentioning

confidence: 99%

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Clinical application of advanced MR methods in children: points to consider

Wilke

Groeschel

Lorenzen

et al. 2018

Ann Clin Transl Neurol

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The application of both functional MRI and diffusion MR tractography prior to a neurosurgical operation is well established in adults, but less so in children, for several reasons. For this review, we have identified several aspects (task design, subject preparation, actual scanning session, data processing, interpretation of results, and decision‐making) where pediatric peculiarities should be taken into account. Further, we not only systematically identify common issues, but also provide solutions, based on our experience as well as a review of the pertinent literature. The aim is to provide the clinician as well as the imaging scientist with information that helps to plan, conduct, and interpret such a clinically‐indicated exam in a way that maximizes benefit for, and minimizes the burden on the individual child.

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“…threshold selection in deterministic DTI. The latest development impacting standard clinic care was the introduction of the nTMS in presurgical DTI-FT, introduced with the intention to standardize ROI seeding (Frey et al, 2012;Krieg et al, 2012;Raffa et al, 2017;Weiss Lucas et al, 2017). In nTMS, a neuronavigation system is used to define functional cortical spots that elicit electromyographic responses (i.e., MEP) in the contralateral limb following magnetic stimulation.…”

Section: Introductionmentioning

confidence: 99%

Neurophysiology-Driven Parameter Selection in nTMS-Based DTI Tractography: A Multidimensional Mathematical Model

et al. 2019

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Object: There is an increasing interest in preoperative diffusion tensor imaging-based fiber tracking (DTI-FT) to preserve function during surgeries in motor eloquent brain regions. However, DTI tractography is challenged by inherent presumptions during particular tracking steps [e.g., deterministic vs. probabilistic DTI, fractional anisotropy (FA) and fiber length (FL) thresholding] and the missing "ground truth" information. In the present study, we intended to establish an objective, neurophysiology-driven approach for parameter selection during DTI-FT of the corticospinal tract integrating both imaging and neurophysiological information. Methods: In ten patients with lesions in eloquent motor areas, preoperative navigated transcranial magnetic stimulation (nTMS) was performed, followed by individual deterministic DTI-FT from a grid of cortical seed points. We investigated over 300 combinations of FA and FL thresholds and applied subsequently a multidimensional mathematical modeling of this empirical data. Optimal DTI parameters were determined by the relationship between DTI-FT (i.e., number of fibers, NoF) and nTMS (i.e., amplitudes of motor-evoked potentials) results. Finally, neurophysiological DTI parameters and the resulting tractography were compared to the current standard approaches of deterministic DTI fiber tracking with a 75% and 50% FA and a FL threshold of 110 mm as well as with intraoperative direct cortical and subcortical stimulation. Results: There was a good goodness-of-fit for the mathematical model (r 2 = 0.68 ± 0 13; range: 0.59-0.97; n = 8) except of two cases. Neurophysiology-driven parameter selection showed a high correlation between DTI-FT and nTMS results (r = 0.73 ± 0.16; range: 0.38-0.93). In comparison to the standard approach, the mathematically calculated thresholds resulted in a higher NoF in 75% of patients. In 50% of patients

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Functional Reconstruction of Motor and Language Pathways Based on Navigated Transcranial Magnetic Stimulation and DTI Fiber Tracking for the Preoperative Planning of Low Grade Glioma Surgery: A New Tool for Preservation and Restoration of Eloquent Networks

Abstract: The functional preoperative mapping of speech and motor pathways based on nTMS and DTI tractography provided useful information, allowing us to plan the best surgical strategy for radical resection; this resulted in improved postoperative neurological results.

Cited by 52 publications

References 13 publications

Current status and potential application of navigated transcranial magnetic stimulation in neurosurgery: a literature review

Current status and potential application of navigated transcranial magnetic stimulation in neurosurgery: a literature review

Clinical application of advanced MR methods in children: points to consider

Neurophysiology-Driven Parameter Selection in nTMS-Based DTI Tractography: A Multidimensional Mathematical Model

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