Department of Neurosurgery, Charité University Hospital, Berlin, Germany.
Neurosurgery. 2012 May;70(5):1248-56; discussion 1256-7. doi: 10.1227/NEU.0b013e318243881e.
Brain tumor surgery near the motor cortex requires careful planning to achieve the optimal balance between completeness of tumor resection and preservation of motor function. Navigated transcranial magnetic stimulation (nTMS) can be used to map functionally essential motor areas preoperatively.
To evaluate how much influence, benefit, and impact nTMS has on the surgical planning for tumors near the motor cortex.
This study reviewed the records of 73 patients with brain tumors in or near the motor cortex, mapped preoperatively with nTMS. The surgical team prospectively classified how much influence the nTMS results had on the surgical planning. Stepwise regression analysis was used to explore which factors predict the amount of influence, benefit, and impact nTMS has on the surgical planning.
The influence of nTMS on the surgical planning was as follows: it confirmed the expected anatomy in 22% of patients, added knowledge that was not used in 23%, added awareness of high-risk areas in 27%, modified the approach in 16%, changed the planned extent of resection in 8%, and changed the surgical indication in 3%.
nTMS had an objective benefit on the surgical planning in one fourth of the patients and a subjective benefit in an additional half of the patients. It had an impact on the surgery itself in just more than half of the patients. By mapping the spatial relationship between the tumor and functional motor cortex, nTMS improves surgical planning for tumors in or near the motor cortex.
靠近运动皮质的脑肿瘤手术需要精心规划，以实现肿瘤切除的完整性和运动功能保留之间的最佳平衡。导航经颅磁刺激（nTMS）可用于术前对功能上重要的运动区域进行定位。
评估 nTMS 对靠近运动皮质的肿瘤手术规划有多大影响、益处和作用。
本研究回顾了 73 例经 nTMS 术前定位的位于或靠近运动皮质的脑肿瘤患者的病历。手术团队前瞻性地对 nTMS 结果对手术规划的影响程度进行分类。采用逐步回归分析探讨哪些因素预测 nTMS 对手术规划的影响、益处和作用。
nTMS 对手术规划的影响如下：它在 22%的患者中证实了预期的解剖结构，在 23%的患者中增加了未使用的知识，在 27%的患者中增加了对高风险区域的认识，在 16%的患者中改变了手术入路，在 8%的患者中改变了预定的切除范围，在 3%的患者中改变了手术适应证。
nTMS 对四分之一的患者的手术规划有客观的益处，对另外一半的患者有主观的益处。超过一半的患者的手术本身受到影响。通过绘制肿瘤与功能运动皮质之间的空间关系，nTMS 改善了靠近运动皮质的肿瘤的手术规划。
