Moser Tobias, Bulubas Lucia, Sabih Jamil, Conway Neal, Wildschutz Noémie, Sollmann Nico, Meyer Bernhard, Ringel Florian, Krieg Sandro M
Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
Neurosurgery. 2017 Jul 1;81(1):99-110. doi: 10.1093/neuros/nyw169.
Navigated transcranial magnetic stimulation (nTMS) helps to determine the distribution of motor eloquent areas prior to brain surgery. Yet, the eloquence of primary motor areas frontal to the precentral gyrus identified via nTMS is unclear.
To investigate the resection of nTMS-positive prerolandic motor areas and its correlation with postsurgical impairment of motor function.
Forty-three patients with rolandic or prerolandic gliomas (WHO grade I-IV) underwent nTMS prior to surgery. Only patients without ischemia within the motor system in postoperative MRI diffusion sequences were enrolled. Based on the 3-dimensional fusion of preoperative nTMS motor mapping data with postsurgical MRI scans, we identified nTMS points that were resected in the infiltration zone of the tumor. We then classified the resected points according to the localization and latency of their motor evoked potentials. Surgery-related paresis was graded as transient (≤6 weeks) or permanent (>6 weeks).
Out of 43, 31 patients (72%) showed nTMS-positive motor points in the prerolandic gyri. In general, 13 out of 43 patients (30%) underwent resection of nTMS points. Ten out of these patients showed postoperative paresis. There were 2 (15%) patients with a transient and 8 (62%) with a permanent surgery-related paresis. In 3 cases (23%), motor function remained unimpaired.
After resection of nTMS-positive motor points, 62% of patients suffered from a new permanent paresis. Thus, even though they are located in the superior or middle frontal gyrus, these cortical areas must undergo intraoperative mapping.
导航经颅磁刺激（nTMS）有助于在脑外科手术前确定运动功能区的分布。然而，通过nTMS确定的中央前回前方初级运动区的功能尚不清楚。
研究nTMS阳性的中央前回前运动区的切除情况及其与术后运动功能障碍的相关性。
43例患有中央前回或中央前回前胶质瘤（世界卫生组织I-IV级）的患者在手术前接受了nTMS检查。仅纳入术后MRI扩散序列中运动系统无缺血的患者。基于术前nTMS运动映射数据与术后MRI扫描的三维融合，我们确定了在肿瘤浸润区内被切除的nTMS点。然后根据其运动诱发电位的定位和潜伏期对切除的点进行分类。手术相关的轻瘫分为短暂性（≤6周）或永久性（>6周）。
43例患者中，31例（72%）在中央前回前回显示nTMS阳性运动点。一般来说，43例患者中有13例（30%）接受了nTMS点的切除。其中10例患者术后出现轻瘫。有2例（15%）患者为短暂性轻瘫，8例（62%）为永久性手术相关轻瘫。3例（23%）患者运动功能未受损。
切除nTMS阳性运动点后，62%的患者出现新的永久性轻瘫。因此，即使这些皮质区域位于额上回或额中回，术中也必须进行定位映射。
