Department of Neurosurgery , Charité-Universitaetsmedizin, Berlin, Germany.
Neurosurgery. 2011 May;68(5):E1475-80; discussion E1480. doi: 10.1227/NEU.0b013e318210c7df.
Navigated brain stimulation (NBS) is an emerging technology that can be used for preoperative mapping of the motor cortex. It combines conventional transcranial magnetic stimulation with neuronavigation and achieves high precision by taking into account all relevant physical factors. In contrast to functional imaging technologies, NBS does not rely on voluntary patient movements for cortical mapping. Thus, NBS can be used even on patients with severe motor impairment.
This article presents the case of a hemiplegic elderly woman with a brain tumor in the motor cortex. Preoperative NBS surprisingly demonstrated intact corticospinal tracts in the hemiplegic patient. The results modified the surgical strategy. Direct cortical stimulation was performed intraoperatively. The direct cortical stimulation results were in agreement with the preoperative NBS findings, and the clinical success of the surgery exceeded expectations.
NBS can be used for preoperative mapping in plegic patients. Even more important, this case report discusses why tumor resection surgery based on NBS may sometimes lead to substantially better clinical outcomes than surgery planned according to functional imaging technologies.
导航脑刺激（NBS）是一种新兴技术，可用于运动皮层的术前映射。它将传统的经颅磁刺激与神经导航相结合，并考虑到所有相关的物理因素，从而实现高精度。与功能成像技术不同，NBS 不依赖于患者的主动运动进行皮层映射。因此，即使对于运动功能严重受损的患者，也可以使用 NBS。
本文报告了一例偏瘫老年女性，大脑运动皮层有肿瘤。术前 NBS 出人意料地显示偏瘫患者的皮质脊髓束完整。结果改变了手术策略。术中进行了直接皮质刺激。直接皮质刺激的结果与术前 NBS 结果一致，手术的临床效果超出预期。
NBS 可用于偏瘫患者的术前映射。更重要的是，本病例报告讨论了为什么基于 NBS 的肿瘤切除术有时可能会导致比基于功能成像技术的手术更好的临床结果。
