Josephine Jung1, José-Pedro Lavrador2, Sabina Patel2, Anastasios Giamouriadis2, Jordan Lam3, Ranjeev Bhangoo2, Keyoumars Ashkan4, Francesco Vergani2. 1. Department of Neurosurgery, King's College Hospital, London, United Kingdom; Neurosciences Clinical Trials Unit, King's College Hospital, London, United Kingdom. Electronic address: Josephine.Jung@nhs.net. 2. Department of Neurosurgery, King's College Hospital, London, United Kingdom. 3. College of Medicine, Biological Sciences and Psychology, University of Leicester, Leicester, United Kingdom. 4. Department of Neurosurgery, King's College Hospital, London, United Kingdom; Neurosciences Clinical Trials Unit, King's College Hospital, London, United Kingdom.
Abstract
BACKGROUND: Surgery for lesions in eloquent brain areas remains challenging owing to the risk of permanent neurological deficits. To date, direct electrical stimulation (DES) and intraoperative neuromonitoring represent the reference standard. Recently, navigated transcranial magnetic stimulation (nTMS) has emerged as a mapping tool to optimize surgical planning. Our aim was to correlate nTMS with the intraoperative findings and assess its effects on surgical decision-making. METHODS: We retrospectively reviewed our series of patients who had undergone craniotomy for removal of a brain tumor at our institution with preoperative nTMS, intraoperative neuromonitoring, and DES from February 2017 to February 2018. Demographic data, tumor entity and location, extent of resection, change in surgical approach, and neurological outcome were collected. RESULTS: Of 35 patients, 24 (68.6%) had undergone preoperative motor mapping and 11 (31.4%) had undergone mapping for language. Histopathological examination demonstrated glioma in 88.6% (high grade, n = 24; low grade, n = 6), metastasis (n = 2), epidermoid cyst (n = 1), and cavernoma (n = 1). nTMS resulted in change in the surgical strategy in 31.5% (craniotomy size, n = 7; access pathway, n = 3; surgical indication, n = 1). The specificity of nTMS for language was 66.7%, with a negative predictive value of 74.1%. nTMS motor mapping correlated with DES in all cases, with a mean abductor pollicis brevis hotspot distance of 3.50 ± 0.66 mm (n = 9). CONCLUSIONS: nTMS is a safe, noninvasive adjunctive tool for preoperative mapping of brain tumors in eloquent areas. Furthermore, nTMS can influence the surgical decisions in up to one third of patients in our experience.
BACKGROUND: Surgery for lesions in eloquent brain areas remains challenging owing to the risk of permanent neurological deficits. To date, direct electrical stimulation (DES) and intraoperative neuromonitoring represent the reference standard. Recently, navigated transcranial magnetic stimulation (nTMS) has emerged as a mapping tool to optimize surgical planning. Our aim was to correlate nTMS with the intraoperative findings and assess its effects on surgical decision-making. METHODS: We retrospectively reviewed our series of patients who had undergone craniotomy for removal of a brain tumor at our institution with preoperative nTMS, intraoperative neuromonitoring, and DES from February 2017 to February 2018. Demographic data, tumor entity and location, extent of resection, change in surgical approach, and neurological outcome were collected. RESULTS: Of 35 patients, 24 (68.6%) had undergone preoperative motor mapping and 11 (31.4%) had undergone mapping for language. Histopathological examination demonstrated glioma in 88.6% (high grade, n = 24; low grade, n = 6), metastasis (n = 2), epidermoid cyst (n = 1), and cavernoma (n = 1). nTMS resulted in change in the surgical strategy in 31.5% (craniotomy size, n = 7; access pathway, n = 3; surgical indication, n = 1). The specificity of nTMS for language was 66.7%, with a negative predictive value of 74.1%. nTMS motor mapping correlated with DES in all cases, with a mean abductor pollicis brevis hotspot distance of 3.50 ± 0.66 mm (n = 9). CONCLUSIONS: nTMS is a safe, noninvasive adjunctive tool for preoperative mapping of brain tumors in eloquent areas. Furthermore, nTMS can influence the surgical decisions in up to one third of patients in our experience.
Authors: Prajwal Ghimire; Jose Pedro Lavrador; Asfand Baig Mirza; Noemia Pereira; Hannah Keeble; Marco Borri; Luciano Furlanetti; Christian Brogna; Jozef Jarosz; Richard Gullan; Francesco Vergani; Ranjeev Bhangoo; Keyoumars Ashkan Journal: Brain Struct Funct Date: 2021-04-19 Impact factor: 3.270
Authors: Josephine Jung; Jignesh Tailor; Emma Dalton; Laurence J Glancz; Joy Roach; Rasheed Zakaria; Simon Lammy; Aswin Chari; Karol P Budohoski; Laurent J Livermore; Kenny Yu; Michael D Jenkinson; Paul M Brennan; Lucy Brazil; Catey Bunce; Elli Bourmpaki; Keyoumars Ashkan; Francesco Vergani Journal: Neurooncol Pract Date: 2019-12-06