Giovanni Raffa1,2,3, Alfredo Conti4, Antonino Scibilia4, Carmela Sindorio4,5, Maria Catena Quattropani6, Massimiliano Visocchi7, Antonino Germanò4, Francesco Tomasello4. 1. Department of Neuroscience, Neurosurgical Clinic, University of Messina, Messina, Italy. mark83g@alice.it. 2. Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy. mark83g@alice.it. 3. A.O.U. Policlinico "G. Martino", Via Consolare Valeria, 1, Messina, 98125, Italy. mark83g@alice.it. 4. Department of Neuroscience, Neurosurgical Clinic, University of Messina, Messina, Italy. 5. Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy. 6. Department of Cognitive Sciences, Psychology, Pedagogy and Cultural Studies, University of Messina, Messina, Italy. 7. Institute of Neurosurgery, Medical School, Catholic University of Rome, Rome, Italy.
Abstract
BACKGROUND: Surgery of low-grade gliomas (LGGs) in eloquent areas still presents a challenge. New technologies have been introduced to enable the performance of "functional", customized preoperative planning aimed at maximal resection, while reducing the risk of postoperative deficits. We describe our experience in the surgery of LGGs in eloquent areas using preoperative planning based on navigated transcranial magnetic stimulation (nTMS) and diffusion tensor imaging (DTI) tractography. METHODS: Sixteen patients underwent preoperative planning, using nTMS and nTMS-based DTI tractography. Motor and language functions were mapped. Preoperative data allowed for tailoring of the surgical strategy. The impact of these modalities on surgical planning was evaluated. Influence on functional outcome was analyzed in comparison with results in a historical control group. RESULTS: In 12 patients (75 %), nTMS added useful information on functional anatomy and surgical risks. Surgical strategy was modified in 9 of 16 cases (56 %). The nTMS "functional approach" provided a good outcome at discharge, with a decrease in postoperative motor and/or language deficits, as compared with controls (6 vs. 44 %; p = 0.03). CONCLUSIONS: 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.
BACKGROUND: Surgery of low-grade gliomas (LGGs) in eloquent areas still presents a challenge. New technologies have been introduced to enable the performance of "functional", customized preoperative planning aimed at maximal resection, while reducing the risk of postoperative deficits. We describe our experience in the surgery of LGGs in eloquent areas using preoperative planning based on navigated transcranial magnetic stimulation (nTMS) and diffusion tensor imaging (DTI) tractography. METHODS: Sixteen patients underwent preoperative planning, using nTMS and nTMS-based DTI tractography. Motor and language functions were mapped. Preoperative data allowed for tailoring of the surgical strategy. The impact of these modalities on surgical planning was evaluated. Influence on functional outcome was analyzed in comparison with results in a historical control group. RESULTS: In 12 patients (75 %), nTMS added useful information on functional anatomy and surgical risks. Surgical strategy was modified in 9 of 16 cases (56 %). The nTMS "functional approach" provided a good outcome at discharge, with a decrease in postoperative motor and/or language deficits, as compared with controls (6 vs. 44 %; p = 0.03). CONCLUSIONS: 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.
Authors: Andrea Di Cristofori; Gianpaolo Basso; Camilla de Laurentis; Ilaria Mauri; Martina Andrea Sirtori; Carlo Ferrarese; Valeria Isella; Carlo Giussani Journal: Front Neurol Date: 2021-02-10 Impact factor: 4.003
Authors: Marko Wilke; Samuel Groeschel; Anna Lorenzen; Sabine Rona; Martin U Schuhmann; Ulrike Ernemann; Ingeborg Krägeloh-Mann Journal: Ann Clin Transl Neurol Date: 2018-09-27 Impact factor: 4.511