Department of Neurosurgery, Johann Wolfgang Goethe University Hospital, Frankfurt am Main, Germany.
Neurosurgery. 2011 May;68(5):1317-24; discussion 1324-5. doi: 10.1227/NEU.0b013e31820b528c.
Tumor resection in the vicinity of the motor cortex poses a challenge to all neurosurgeons. For preoperative assessment of eloquent cortical areas, functional magnetic resonance imaging (fMRI) is used, whereas intraoperatively, direct cortical stimulation (DCS) is performed. Navigated transcranial magnetic stimulation (nTMS) is comparable to DCS in activating cortical pyramidal neurons.
To evaluate the reliability of nTMS compared with fMRI and DCS for preoperative resection planning of centrally located tumors.
In a prospective series, 11 patients (ages, 20-63 years; mean, 41.9 ± 14.9 years, 2 women) with tumors located in or adjacent to the motor cortex were evaluated for surgery. fMRI and nTMS were applied for preoperative assessment of the extent of tumor resection. A 3-dimensional anatomic data set with superimposed fMRI data was integrated in the eXimia Navigated Brain Stimulation station for ensuing motor cortex mapping by nTMS. Responses from nTMS were evaluated by electromyographic response. During surgery, the coordinates of each DCS site were unambiguously defined and integrated into neuronavigation. A post hoc comparison of the coordinates of nTMS, fMRI, and DCS was performed.
Distances from nTMS to DCS (10.5 ± 5.67 mm) were significantly smaller than those from fMRI to DCS (15.0 ± 7.6 mm).
nTMS anticipates information usually only enabled by DCS and therefore allows surgical planning in eloquent cortex surgery.
肿瘤切除靠近运动皮层对所有神经外科医生来说都是一个挑战。对于语言相关皮质区的术前评估，使用功能磁共振成像（fMRI），而在术中，进行直接皮质刺激（DCS）。经颅磁刺激导航（nTMS）在激活皮质锥体神经元方面与 DCS 相当。
评估 nTMS 与 fMRI 和 DCS 相比在中央部位肿瘤的术前切除规划中的可靠性。
在一项前瞻性系列研究中，评估了 11 名（年龄 20-63 岁；平均 41.9±14.9 岁，女性 2 名）肿瘤位于或靠近运动皮层的患者进行手术。fMRI 和 nTMS 用于评估肿瘤切除范围的术前评估。将具有叠加 fMRI 数据的三维解剖数据集整合到 eXimia 经颅磁刺激导航刺激站中，以通过 nTMS 进行运动皮层映射。通过肌电图反应评估 nTMS 的反应。在手术过程中，每个 DCS 部位的坐标都被明确定义并整合到神经导航中。对 nTMS、fMRI 和 DCS 的坐标进行了事后比较。
nTMS 与 DCS 之间的距离（10.5±5.67mm）明显小于 fMRI 与 DCS 之间的距离（15.0±7.6mm）。
nTMS 预测了通常只有 DCS 才能提供的信息，因此允许在语言相关皮质手术中进行手术规划。
