术前多模态运动映射：脑磁图成像、经颅磁刺激导航与皮质直接刺激的比较。
Preoperative multimodal motor mapping: a comparison of magnetoencephalography imaging, navigated transcranial magnetic stimulation, and direct cortical stimulation.
机构信息
Department of Neurological Surgery, University of California, San Francisco, California 94143, USA.
出版信息
J Neurosurg. 2012 Aug;117(2):354-62. doi: 10.3171/2012.5.JNS112124. Epub 2012 Jun 15.
OBJECT
Direct cortical stimulation (DCS) is the gold-standard technique for motor mapping during craniotomy. However, preoperative noninvasive motor mapping is becoming increasingly accurate. Two such noninvasive modalities are navigated transcranial magnetic stimulation (TMS) and magnetoencephalography (MEG) imaging. While MEG imaging has already been extensively validated as an accurate modality of noninvasive motor mapping, TMS is less well studied. In this study, the authors compared the accuracy of TMS to both DCS and MEG imaging.
METHODS
Patients with tumors in proximity to primary motor cortex underwent preoperative TMS and MEG imaging for motor mapping. The patients subsequently underwent motor mapping via intraoperative DCS. The loci of maximal response were recorded from each modality and compared. Motor strength was assessed at 3 months postoperatively.
RESULTS
Transcranial magnetic stimulation and MEG imaging were performed on 24 patients. Intraoperative DCS yielded 8 positive motor sites in 5 patients. The median distance ± SEM between TMS and DCS motor sites was 2.13 ± 0.29 mm, and between TMS and MEG imaging motor sites was 4.71 ± 1.08 mm. In no patients did DCS motor mapping reveal a motor site that was unrecognized by TMS. Three of 24 patients developed new, early neurological deficit in the form of upper-extremity paresis. At the 3-month follow-up evaluation, 2 of these patients were significantly improved, experiencing difficulty only with fine motor tasks; the remaining patient had improvement to 4/5 strength. There were no deaths over the course of the study.
CONCLUSIONS
Maps of the motor system generated with TMS correlate well with those generated by both MEG imaging and DCS. Negative TMS mapping also correlates with negative DCS mapping. Navigated TMS is an accurate modality for noninvasively generating preoperative motor maps.
目的
直接皮质刺激（DCS）是开颅术中运动映射的金标准技术。然而，术前非侵入性运动映射变得越来越准确。两种非侵入性方式是经颅磁刺激（TMS）和脑磁图（MEG）成像。虽然 MEG 成像已被广泛验证为非侵入性运动映射的准确方式，但 TMS 的研究较少。在这项研究中，作者比较了 TMS 与 DCS 和 MEG 成像的准确性。
方法
肿瘤靠近初级运动皮层的患者接受术前 TMS 和 MEG 成像进行运动映射。随后，患者接受术中 DCS 进行运动映射。记录来自每种方式的最大反应部位，并进行比较。术后 3 个月评估运动力量。
结果
24 名患者接受了 TMS 和 MEG 成像。术中 DCS 在 5 名患者中产生了 8 个阳性运动部位。TMS 和 DCS 运动部位之间的中位数距离±SEM 为 2.13±0.29mm，TMS 和 MEG 成像运动部位之间的中位数距离为 4.71±1.08mm。在没有患者中，DCS 运动映射未发现 TMS 无法识别的运动部位。24 名患者中有 3 名出现新的早期神经功能缺损，表现为上肢无力。在 3 个月的随访评估中，其中 2 名患者显著改善，仅在精细运动任务中存在困难；其余患者的力量改善至 4/5。研究过程中无死亡。
结论
TMS 生成的运动系统图与 MEG 成像和 DCS 生成的图很好地相关。TMS 阴性映射也与 DCS 阴性映射相关。经颅导航 TMS 是一种准确的非侵入性生成术前运动图的方式。
Zotero 插件