Division of Functional Neurosurgery, Hospital das Clinicas, University of São Paulo School of Medicine, São Paulo, Brazil.
Neuropsychiatr Dis Treat. 2012;8:197-201. doi: 10.2147/NDT.S30151. Epub 2012 May 3.
Transcranial magnetic stimulation (TMS) is a promising method for both investigation and therapeutic treatment of psychiatric and neurologic disorders and, more recently, for brain mapping. This study describes the application of navigated TMS for motor cortex mapping in patients with a brain tumor located close to the precentral gyrus.
In this prospective study, six patients with low-grade gliomas in or near the precentral gyrus underwent TMS, and their motor responses were correlated to locations in the cortex around the lesion, generating a functional map overlaid on three-dimensional magnetic resonance imaging (MRI) scans of the brain. To determine the accuracy of this new method, we compared TMS mapping with the gold standard mapping with direct cortical electrical stimulation in surgery. The same navigation system and TMS-generated map were used during the surgical resection procedure.
The motor cortex could be clearly mapped using both methods. The locations corresponding to the hand and forearm, found during intraoperative mapping, showed a close spatial relationship to the homotopic areas identified by TMS mapping. The mean distance between TMS and direct cortical electrical stimulation (DES) was 4.16 ± 1.02 mm (range: 2.56-5.27 mm).
Preoperative mapping of the motor cortex with navigated TMS prior to brain tumor resection is a useful presurgical planning tool with good accuracy.
经颅磁刺激（TMS）是一种有前途的方法，可用于调查和治疗精神和神经疾病，最近还可用于大脑映射。本研究描述了经颅磁刺激在靠近中央前回的脑肿瘤患者中进行运动皮层映射的应用。
在这项前瞻性研究中，六名位于中央前回或附近的低级别胶质瘤患者接受了 TMS，他们的运动反应与病变周围皮层的位置相关联，生成一个叠加在大脑三维磁共振成像（MRI）扫描上的功能图。为了确定这种新方法的准确性，我们将 TMS 映射与手术中直接皮质电刺激的金标准映射进行了比较。在手术切除过程中使用了相同的导航系统和 TMS 生成的地图。
两种方法都可以清楚地映射运动皮层。术中映射时发现的对应于手和前臂的位置与 TMS 映射确定的同源区域具有紧密的空间关系。TMS 和直接皮质电刺激（DES）之间的平均距离为 4.16±1.02mm（范围：2.56-5.27mm）。
在脑肿瘤切除术前用导航 TMS 对运动皮层进行术前映射是一种有用的术前规划工具，具有良好的准确性。
