Sebastian Ille1,2, Nico Sollmann1,2, Vicki M Butenschoen1,2, Bernhard Meyer1, Florian Ringel1, Sandro M Krieg3,4. 1. Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany. 2. TUM Neuroimaging Center, Klinikum rechts der Isar, Technische Universität München, Munich, Germany. 3. Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany. Sandro.Krieg@tum.de. 4. TUM Neuroimaging Center, Klinikum rechts der Isar, Technische Universität München, Munich, Germany. Sandro.Krieg@tum.de.
Abstract
BACKGROUND: The resection of left-sided perisylvian brain lesions harbours the risk of postoperative language impairment. Therefore the individual patient's language distribution is investigated by intraoperative direct cortical stimulation (DCS) during awake surgery. Yet, not all patients qualify for awake surgery. Non-invasive language mapping by repetitive navigated transcranial magnetic stimulation (rTMS) has frequently shown a high correlation in comparison with the results of DCS language mapping in terms of language-negative brain regions. The present study analyses the extent of resection (EOR) and functional outcome of patients who underwent left-sided perisylvian resection of brain lesions based purely on rTMS language mapping. METHODS: Four patients with left-sided perisylvian brain lesions (two gliomas WHO III, one glioblastoma, one cavernous angioma) underwent rTMS language mapping prior to surgery. Data from rTMS language mapping and rTMS-based diffusion tensor imaging fibre tracking (DTI-FT) were transferred to the intraoperative neuronavigation system. Preoperatively, 5 days after surgery (POD5), and 3 months after surgery (POM3) clinical follow-up examinations were performed. RESULTS: No patient suffered from a new surgery-related aphasia at POM3. Three patients underwent complete resection immediately, while one patient required a second rTMS-based resection some days later to achieve the final, complete resection. CONCLUSIONS: The present study shows for the first time the feasibility of successfully resecting language-eloquent brain lesions based purely on the results of negative language maps provided by rTMS language mapping and rTMS-based DTI-FT. In very select cases, this technique can provide a rescue strategy with an optimal functional outcome and EOR when awake surgery is not feasible.
BACKGROUND: The resection of left-sided perisylvian brain lesions harbours the risk of postoperative language impairment. Therefore the individual patient's language distribution is investigated by intraoperative direct cortical stimulation (DCS) during awake surgery. Yet, not all patients qualify for awake surgery. Non-invasive language mapping by repetitive navigated transcranial magnetic stimulation (rTMS) has frequently shown a high correlation in comparison with the results of DCS language mapping in terms of language-negative brain regions. The present study analyses the extent of resection (EOR) and functional outcome of patients who underwent left-sided perisylvian resection of brain lesions based purely on rTMS language mapping. METHODS: Four patients with left-sided perisylvian brain lesions (two gliomas WHO III, one glioblastoma, one cavernous angioma) underwent rTMS language mapping prior to surgery. Data from rTMS language mapping and rTMS-based diffusion tensor imaging fibre tracking (DTI-FT) were transferred to the intraoperative neuronavigation system. Preoperatively, 5 days after surgery (POD5), and 3 months after surgery (POM3) clinical follow-up examinations were performed. RESULTS: No patient suffered from a new surgery-related aphasia at POM3. Three patients underwent complete resection immediately, while one patient required a second rTMS-based resection some days later to achieve the final, complete resection. CONCLUSIONS: The present study shows for the first time the feasibility of successfully resecting language-eloquent brain lesions based purely on the results of negative language maps provided by rTMS language mapping and rTMS-based DTI-FT. In very select cases, this technique can provide a rescue strategy with an optimal functional outcome and EOR when awake surgery is not feasible.
Entities:
Keywords:
Awake surgery; Diffusion tensor imaging fibre tracking; Direct cortical stimulation language mapping; Repetitive transcranial magnetic stimulation
Authors: Christian F Freyschlag; Sandro M Krieg; Johannes Kerschbaumer; Daniel Pinggera; Marie-Therese Forster; Dominik Cordier; Marco Rossi; Gabriele Miceli; Alexandre Roux; Andrés Reyes; Silvio Sarubbo; Anja Smits; Joanna Sierpowska; Pierre A Robe; Geert-Jan Rutten; Thomas Santarius; Tomasz Matys; Marc Zanello; Fabien Almairac; Lydiane Mondot; Asgeir S Jakola; Maria Zetterling; Adrià Rofes; Gord von Campe; Remy Guillevin; Daniele Bagatto; Vincent Lubrano; Marion Rapp; John Goodden; Philip C De Witt Hamer; Johan Pallud; Lorenzo Bello; Claudius Thomé; Hugues Duffau; Emmanuel Mandonnet Journal: J Neurooncol Date: 2018-07-10 Impact factor: 4.130
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