Postoperative navigated transcranial magnetic stimulation to predict motor recovery after surgery of tumors in motor eloquent areas |
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| Affiliation: | 1. Department of Neurosurgery, Universitätsmedizin Göttingen, Göttingen, Germany;2. European Association of Neurosurgical Societies, Diversity in Neurosurgery Task Force, Brussels, Belgium;3. Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom;4. University of California-San Francisco School of Medicine, San Francisco, CA, United States;5. Tawam Hospital, Al Ain, Abu Dhabi, United Arab Emirates;6. Department of Neurosurgery, Haaglanden Medical Center, The Hague, Zuid-Holland, the Netherlands;7. Department of Neurosurgery, Leiden University Medical Center, Leiden, Zuid-Holland, the Netherlands;8. Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States;9. Department of Neurosurgery, Universitair Ziekenhuis Antwerpen, Edegem, Belgium;10. Department of Neurosurgery, Centre Hospitalier Universitaire Liège, Liège, Belgium;11. Department of Neurosurgery, University Hospital of Caen, Caen Normandie University, Caen, France;12. Department of Neurosurgery, Demiroglu Bilim University - Medical School, İstanbul, Turkey;13. Department of Neurosurgery, Tel Aviv Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel;14. Department of Neurosurgery, University Hospital Geneva, Geneva, Switzerland;15. Department of Neurosurgery, Nicosia General Hospital, Nicosia, Cyprus;p. Neuroscience Department, JSC Evex, M.Iashvili Children''''s Central Hospital, Tbilisi, Georgia;q. Department of Neurosurgery, University Hospital of Larissa, Thessaly, Greece;r. Department of Neurosurgery, Ospedali Riuniti di Livorno, Livorno, Italy;s. Upper Valley Neurology Neurosurgery, Lebanon, NH, United States;t. Department of Neurosurgery, University Hospital “St. Ivan Rilski” Sofia, Bulgaria;u. Department of Neuroscience, University Hospital “Mother Theresa”, Tirana, Albania;v. Institution of Neuroscience & Physiology, Sahlgrenska Academy, Gothenberg, Sweden;w. Department of Neurological Surgery, Germans Trias i Pujol University Hospital, Barcelona, Spain;x. Department of Neurosurgery, George Washington University School of Medicine and Health Sciences, Washington, DC, United States;1. Department of Neurology, University Campus Bio-Medico, Rome, Italy;2. Department of Computer Science and Computer Engineering, University Campus Bio-Medico, Rome, Italy;3. Department of Clinical Neurophysiology, Kuopio University Hospital, University of Eastern Finland, Kuopio, Finland;4. Service of Medical Statistics and Information Technology, Fatebenefratelli Foundation for Health Research and Education, AFaR Division, Rome, Italy;5. Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland;6. Department of Physical Medicine and Rehabilitation, University Campus Biomedico, Rome, Italy;7. Institute of Neurology, Dept. Geriatrics, Neurosciences, Orthopaedics, Policlinic A. Gemelli, Catholic University, Rome, Italy;8. IRCCS S. Raffaele-Pisana, Rome, Italy;1. Department of Neurosurgery, IRCCS Neuromed, Pozzilli (IS), Italy;2. Department of Neurology and Psychiatry, Sapienza University, Rome, Italy;1. Trinity College Institute of Neuroscience and School of Psychology, Lloyd Building, Trinity College Dublin, Dublin 2, Ireland;2. Academic Unit of Neurology, 152-160 Pearse St., Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin 2, Ireland;3. School of Psychology, Queen’s University Belfast, David Keir Building, 18-30 Malone Road, Belfast BT9 5BN, Northern Ireland, UK |
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| Abstract: | ObjectiveTo know whether motor deficits after tumor surgery are transient is reassuring for the patient and crucial for planning rehabilitation and adjuvant treatment. We analyze the value of postoperative MRI navigated transcranial magnetic stimulation (nTMS) compared to intraoperative MEP monitoring in predicting recovery of motor function.MethodsRetrospective series of nTMS mappings within 14 days after surgery for supratentorial tumors (09/2014–05/2018). All patients with motor deficits of Medical-Research-Council-Grade (MRCS) 0–4- were included.ResultsWe performed nTMS mapping on average 3.8 days after surgery and recorded nTMS MEP in 11 of 13 patients. Motor strength recovered to at least MRCS 4 within one month if postoperative nTMS elicited MEPs (positive predictive value 90.9%). If nTMS did not elicit MEPs, the patient did not recover (negative predictive value 100%). Intraoperative MEP and postoperative nTMS were equally predictive for long-term motor recovery. In cases of intraoperative MEP alteration/signal loss, but a positive postoperative nTMS mapping, 2/3 patients demonstrated a good motor recovery.ConclusionnTMS may predict long-term motor recovery of patients suffering from severe motor deficits directly after resection of tumors located in motor eloquent areas.SignificanceIn cases of intraoperative MEP alterations, postoperative nTMS may clarify the potential for motor recovery. |
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| Keywords: | Brain tumor surgery Intraoperative neurophysiological monitoring Brain mapping Motor evoked potential Transcranial magnetic stimulation CST" },{" #name" :" keyword" ," $" :{" id" :" k0035" }," $$" :[{" #name" :" text" ," _" :" corticospinal tract Cing" },{" #name" :" keyword" ," $" :{" id" :" k0045" }," $$" :[{" #name" :" text" ," _" :" Cingulum CUSA" },{" #name" :" keyword" ," $" :{" id" :" k0055" }," $$" :[{" #name" :" text" ," _" :" Cavitron Ultrasonic Surgical Aspirator DCS MEP" },{" #name" :" keyword" ," $" :{" id" :" k0065" }," $$" :[{" #name" :" text" ," _" :" direct cortical stimulation elicited MEP DPM" },{" #name" :" keyword" ," $" :{" id" :" k0075" }," $$" :[{" #name" :" text" ," _" :" dorsal premotor area IOM" },{" #name" :" keyword" ," $" :{" id" :" k0085" }," $$" :[{" #name" :" text" ," _" :" intraoperative neurophysiological monitoring M1" },{" #name" :" keyword" ," $" :{" id" :" k0095" }," $$" :[{" #name" :" text" ," _" :" primary motor area MRCS" },{" #name" :" keyword" ," $" :{" id" :" k0105" }," $$" :[{" #name" :" text" ," _" :" Medical Research Council Scale MEP" },{" #name" :" keyword" ," $" :{" id" :" k0115" }," $$" :[{" #name" :" text" ," _" :" motor evoked potential MT" },{" #name" :" keyword" ," $" :{" id" :" k0125" }," $$" :[{" #name" :" text" ," _" :" motor threshold nTMS" },{" #name" :" keyword" ," $" :{" id" :" k0135" }," $$" :[{" #name" :" text" ," _" :" navigated transcranial magnetic stimulation RMT" },{" #name" :" keyword" ," $" :{" id" :" k0145" }," $$" :[{" #name" :" text" ," _" :" resting motor threshold SMA" },{" #name" :" keyword" ," $" :{" id" :" k0155" }," $$" :[{" #name" :" text" ," _" :" supplementary motor area TES MEP" },{" #name" :" keyword" ," $" :{" id" :" k0165" }," $$" :[{" #name" :" text" ," _" :" transcranial electrical stimulation elicited MEP VPM" },{" #name" :" keyword" ," $" :{" id" :" k0175" }," $$" :[{" #name" :" text" ," _" :" ventral premotor area |
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