Haddad Alexander F, Young Jacob S, Berger Mitchel S, Tarapore Phiroz E
School of Medicine, University of California, San Francisco, San Francisco, CA, United States.
Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, United States.
Front Neurol. 2021 Jan 22;11:628903. doi: 10.3389/fneur.2020.628903. eCollection 2020.
Preoperative mapping of cortical structures prior to neurosurgical intervention can provide a roadmap of the brain with which neurosurgeons can navigate critical cortical structures. In patients undergoing surgery for brain tumors, preoperative mapping allows for improved operative planning, patient risk stratification, and personalized preoperative patient counseling. Navigated transcranial magnetic stimulation (nTMS) is one modality that allows for highly accurate, image-guided, non-invasive stimulation of the brain, thus allowing for differentiation between eloquent and non-eloquent cortical regions. Motor mapping is the best validated application of nTMS, yielding reliable maps with an accuracy similar to intraoperative cortical mapping. Language mapping is also commonly performed, although nTMS language maps are not as highly concordant with direct intraoperative cortical stimulation maps as nTMS motor maps. Additionally, nTMS has been used to localize cortical regions involved in other functions such as facial recognition, calculation, higher-order motor processing, and visuospatial orientation. In this review, we evaluate the growing literature on the applications of nTMS in the preoperative setting. First, we analyze the evidence in support of the most common clinical applications. Then we identify usages that show promise but require further validation. We also discuss developing nTMS techniques that are still in the experimental stage, such as the use of nTMS to enhance postoperative recovery. Finally, we highlight practical considerations when utilizing nTMS and, importantly, its safety profile in neurosurgical patients. In so doing, we aim to provide a comprehensive review of the role of nTMS in the neurosurgical management of a patient with a brain tumor.
在神经外科手术干预前对皮质结构进行术前映射，可以提供一个脑图谱，神经外科医生可以据此定位关键的皮质结构。在接受脑肿瘤手术的患者中，术前映射有助于改进手术规划、进行患者风险分层以及开展个性化的术前患者咨询。导航经颅磁刺激（nTMS）是一种能够对大脑进行高精度、图像引导的非侵入性刺激的方法，从而能够区分明确功能的皮质区域和无明确功能的皮质区域。运动映射是nTMS最有效的应用，能产生可靠性与术中皮质映射相似的图谱。语言映射也经常进行，尽管nTMS语言图谱与术中直接皮质刺激图谱的一致性不如nTMS运动图谱。此外，nTMS已被用于定位参与其他功能的皮质区域，如面部识别、计算、高级运动处理和视觉空间定向。在本综述中，我们评估了关于nTMS在术前应用的不断增长的文献。首先，我们分析支持最常见临床应用的证据。然后我们确定有前景但需要进一步验证的应用。我们还讨论了仍处于实验阶段的nTMS技术的发展，如使用nTMS促进术后恢复。最后，我们强调使用nTMS时的实际考虑因素，重要的是，其在神经外科患者中的安全性。通过这样做，我们旨在全面综述nTMS在脑肿瘤患者神经外科治疗中的作用。
