Nico Sollmann1, Haosu Zhang2, Anna Kelm3, Axel Schröder4, Bernhard Meyer5, Minna Pitkänen6, Petro Julkunen7, Sandro M Krieg8. 1. Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675 Munich, Germany; TUM-Neuroimaging Center, Klinikum rechts der Isar, Technische Universität München, Munich, Germany. Electronic address: Nico.Sollmann@tum.de. 2. Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675 Munich, Germany. 3. Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675 Munich, Germany. Electronic address: Anna.Kelm@tum.de. 4. Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675 Munich, Germany. Electronic address: Axel.Schroeder@tum.de. 5. Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675 Munich, Germany. Electronic address: Bernhard.Meyer@tum.de. 6. Department of Clinical Neurophysiology, Kuopio University Hospital, POB 100, 70029 KYS, Kuopio, Finland; A. I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland; Department of Neuroscience and Biomedical Engineering, Aalto University School of Science, Espoo, Finland. 7. Department of Clinical Neurophysiology, Kuopio University Hospital, POB 100, 70029 KYS, Kuopio, Finland; Department of Applied Physics, University of Eastern Finland, Kuopio, Finland. Electronic address: Petro.Julkunen@kuh.fi. 8. TUM-Neuroimaging Center, Klinikum rechts der Isar, Technische Universität München, Munich, Germany; Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675 Munich, Germany. Electronic address: Sandro.Krieg@tum.de.
Abstract
OBJECTIVE: Single-pulse navigated transcranial magnetic stimulation (sp-nTMS) is used for presurgical motor mapping in patients with motor-eloquent lesions. However, recently introduced paired-pulse nTMS (pp-nTMS) with biphasic pulses could improve motor mapping. METHODS: Thirty-four patients (mean age: 56.0 ± 12.7 years, 53.0% high-grade glioma) with motor-eloquent lesions underwent motor mapping of upper extremity representations and nTMS-based tractography of the corticospinal tract (CST) by both sp-nTMS and pp-nTMS with biphasic pulses for the tumor-affected hemisphere before resection. RESULTS: In three patients (8.8%), conventional sp-nTMS did not provide motor-positive points, in contrast to pp-nTMS that was capable of generating motor maps in all patients. Good concordance between pp-nTMS and sp-nTMS in the spatial location of motor hotspots and center of gravity (CoG) as well as for CST tracking was observed, with pp-nTMS leading to similar motor map volumes (585.0 ± 667.8 vs. 586.8 ± 204.2 mm3, p = 0.9889) with considerably lower resting motor thresholds (35.0 ± 8.8 vs. 32.8 ± 7.6% of stimulator output, p = 0.0004). CONCLUSIONS: Pp-nTMS with biphasic pulses may provide motor maps even in highly demanding cases with tumor-affected motor structures or edema, using lower stimulation intensity compared to sp-nTMS. SIGNIFICANCE: Pp-nTMS with biphasic pulses could replace standardly used sp-nTMS for motor mapping and may be safer due to lower stimulation intensity.
OBJECTIVE: Single-pulse navigated transcranial magnetic stimulation (sp-nTMS) is used for presurgical motor mapping in patients with motor-eloquent lesions. However, recently introduced paired-pulse nTMS (pp-nTMS) with biphasic pulses could improve motor mapping. METHODS: Thirty-four patients (mean age: 56.0 ± 12.7 years, 53.0% high-grade glioma) with motor-eloquent lesions underwent motor mapping of upper extremity representations and nTMS-based tractography of the corticospinal tract (CST) by both sp-nTMS and pp-nTMS with biphasic pulses for the tumor-affected hemisphere before resection. RESULTS: In three patients (8.8%), conventional sp-nTMS did not provide motor-positive points, in contrast to pp-nTMS that was capable of generating motor maps in all patients. Good concordance between pp-nTMS and sp-nTMS in the spatial location of motor hotspots and center of gravity (CoG) as well as for CST tracking was observed, with pp-nTMS leading to similar motor map volumes (585.0 ± 667.8 vs. 586.8 ± 204.2 mm3, p = 0.9889) with considerably lower resting motor thresholds (35.0 ± 8.8 vs. 32.8 ± 7.6% of stimulator output, p = 0.0004). CONCLUSIONS:Pp-nTMS with biphasic pulses may provide motor maps even in highly demanding cases with tumor-affected motor structures or edema, using lower stimulation intensity compared to sp-nTMS. SIGNIFICANCE: Pp-nTMS with biphasic pulses could replace standardly used sp-nTMS for motor mapping and may be safer due to lower stimulation intensity.
Authors: Marco Ciavarro; Eleonora Grande; Luigi Pavone; Giuseppina Bevacqua; Michelangelo De Angelis; Paolo di Russo; Roberta Morace; Giorgia Committeri; Giovanni Grillea; Marcello Bartolo; Sergio Paolini; Vincenzo Esposito Journal: Front Neurol Date: 2021-05-14 Impact factor: 4.003
Authors: Haosu Zhang; Sebastian Ille; Lisa Sogerer; Maximilian Schwendner; Axel Schröder; Bernhard Meyer; Benedikt Wiestler; Sandro M Krieg Journal: Hum Brain Mapp Date: 2021-12-23 Impact factor: 5.038