Coburger Jan, Karhu Jari, Bittl Markus, Hopf Nikolai J
Department of Neurosurgery, Klinikum Stuttgart, Germany.
J Neurosurg Pediatr. 2012 Jun;9(6):660-4. doi: 10.3171/2012.2.PEDS11426.
Preoperative functional mapping in children younger than 5 years old remains a challenge. Awake functional MRI (fMRI) is usually not an option for these patients. Except for a description of passive fMRI in sedated patients and magnetoencephalography, no other noninvasive mapping method has been reported as a preoperative diagnostic tool in children. Therefore, invasive intraoperative direct cortical stimulation remains the method of choice. To the authors' knowledge, this is the first case of a young child undergoing preoperative functional motor cortex mapping with the aid of navigated transcranial magnetic stimulation (nTMS). In this 3-year-old boy with a rolandic ganglioglioma, awake preoperative mapping was performed using nTMS. A precise location of Broca area 4 could be established. The surgical approach was planned according to the preoperative findings. Intraoperative direct cortical stimulation verified the location of the nTMS hotspots, and complete resection of the precentral tumor was achieved. Navigated TMS is a precise tool for preoperative motor cortex mapping and is feasible even in very young pediatric patients. In children for whom performing the fMRI motor paradigm is challenging, nTMS is the only available option for functional mapping.
对5岁以下儿童进行术前功能定位仍是一项挑战。清醒状态下的功能磁共振成像（fMRI）通常不适用于这些患者。除了对镇静患者的被动fMRI和脑磁图的描述外，尚无其他非侵入性定位方法被报道可作为儿童术前诊断工具。因此，有创术中直接皮质刺激仍是首选方法。据作者所知，这是首例借助导航经颅磁刺激（nTMS）对幼儿进行术前功能性运动皮质定位的病例。在这名患有中央沟神经节胶质瘤的3岁男孩中，使用nTMS进行了清醒状态下的术前定位。可以确定布罗卡区4的精确位置。根据术前检查结果规划了手术入路。术中直接皮质刺激验证了nTMS热点的位置，并且实现了中央前回肿瘤的完全切除。导航经颅磁刺激是术前运动皮质定位的精确工具，即使在非常年幼的儿科患者中也是可行的。对于那些进行fMRI运动范式具有挑战性的儿童，nTMS是功能定位的唯一可用选择。
