Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Germany.
Clin Neurophysiol. 2013 Mar;124(3):522-7. doi: 10.1016/j.clinph.2012.08.011. Epub 2012 Sep 15.
Navigated transcranial magnetic stimulation (nTMS) has been repeatedly shown to be comparably accurate to direct cortical stimulation (DCS) for rolandic region mapping. However, there are no data on its use for recurrent gliomas in which scarring and radiotherapy can impair nTMS. We therefore evaluated the accuracy of nTMS versus DCS and functional MRI (fMRI) in recurrent gliomas compared to initially operated tumors.
We examined 8 patients with recurrent gliomas and 23 patients with initially operated lesions in or adjacent to the precentral gyrus by preoperative nTMS.
Preoperative motor mapping correlated well with intraoperative DCS in recurrent gliomas (6.2±6.0mm), as well as in newly diagnosed tumor patients (5.7±4.6mm) with no significant difference. Compared to fMRI, the difference was larger for upper (recurrent: 8.5±7.2mm; new: 9.8±8.6mm) and lower (recurrent: 17.1±10.6mm; new: 13.8±13.0mm) extremities, with no significant differences.
When comparing nTMS with DCS and fMRI, nTMS is as accurate in recurrent gliomas as it is prior to the first operation. It should be considered a helpful modality in recurrent glioma patients as well.
nTMS is also applicable in recurrent tumors.
经颅磁刺激导航（nTMS）在罗兰多区域定位方面已被反复证明与皮层直接刺激（DCS）相当准确。然而，在瘢痕和放疗会影响 nTMS 的复发性胶质瘤中，尚无关于其使用的数据。因此，我们评估了 nTMS 与 DCS 和功能磁共振成像（fMRI）在复发性胶质瘤中的准确性，与最初手术的肿瘤进行了比较。
我们通过术前 nTMS 检查了 8 例复发性胶质瘤患者和 23 例位于或邻近中央前回的初次手术患者。
复发性胶质瘤患者的术前运动图与术中 DCS 相关性良好（6.2±6.0mm），与新诊断肿瘤患者（5.7±4.6mm）无显著差异。与 fMRI 相比，上肢（复发性：8.5±7.2mm；新诊断：9.8±8.6mm）和下肢（复发性：17.1±10.6mm；新诊断：13.8±13.0mm）的差异更大，但无统计学差异。
将 nTMS 与 DCS 和 fMRI 进行比较时，nTMS 在复发性胶质瘤中的准确性与首次手术前相同。它也应该被认为是复发性胶质瘤患者的一种有用的方法。
nTMS 也适用于复发性肿瘤。
