1
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El-Ghandour NMF. Commentary: Awake Craniotomy for a Ruptured Arteriovenous Malformation With Preoperative Navigated Transcranial Magnetic Stimulation for Language Mapping: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2024; 26:111-112. [PMID: 37815232 DOI: 10.1227/ons.0000000000000912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Accepted: 08/08/2023] [Indexed: 10/11/2023] Open
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2
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Gerritsen JKW, Broekman MLD, De Vleeschouwer S, Schucht P, Nahed BV, Berger MS, Vincent AJPE. Safe Surgery for Glioblastoma: Recent Advances and Modern Challenges. Neurooncol Pract 2022; 9:364-379. [PMID: 36127890 PMCID: PMC9476986 DOI: 10.1093/nop/npac019] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
One of the major challenges during glioblastoma surgery is balancing between maximizing extent of resection and preventing neurological deficits. Several surgical techniques and adjuncts have been developed to help identify eloquent areas both preoperatively (fMRI, nTMS, MEG, DTI) and intraoperatively (imaging (ultrasound, iMRI), electrostimulation (mapping), cerebral perfusion measurements (fUS)), and visualization (5-ALA, fluoresceine)). In this review, we give an update of the state-of-the-art management of both primary and recurrent glioblastomas. We will review the latest surgical advances, challenges, and approaches that define the onco-neurosurgical practice in a contemporary setting and give an overview of the current prospective scientific efforts.
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Affiliation(s)
| | | | | | - Philippe Schucht
- Department of Neurosurgery, University Hospital Bern, Switzerland
| | - Brian Vala Nahed
- Department of Neurosurgery, Massachusetts General Hospital/Harvard Medical School, Boston MA, USA
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3
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Muir M, Patel R, Traylor J, de Almeida Bastos DC, Prinsloo S, Liu HL, Noll K, Wefel J, Tummala S, Kumar V, Prabhu S. Validation of Non-invasive Language Mapping Modalities for Eloquent Tumor Resection: A Pilot Study. Front Neurosci 2022; 16:833073. [PMID: 35299624 PMCID: PMC8923233 DOI: 10.3389/fnins.2022.833073] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 01/13/2022] [Indexed: 11/13/2022] Open
Abstract
Many studies have established a link between extent of resection and survival in patients with gliomas. Surgeons must optimize the oncofunctional balance by maximizing the extent of resection and minimizing postoperative neurological morbidity. Preoperative functional imaging modalities are important tools for optimizing the oncofunctional balance. Transcranial magnetic stimulation (TMS) and functional magnetic resonance imaging (fMRI) are non-invasive imaging modalities that can be used for preoperative functional language mapping. Scarce data exist evaluating the accuracy of these preoperative modalities for language mapping compared with gold standard intraoperative data in the same cohort. This study compares the accuracy of fMRI and TMS for language mapping compared with intraoperative direct cortical stimulation (DCS). We also identified significant predictors of preoperative functional imaging accuracy, as well as significant predictors of functional outcomes. Evidence from this study could inform clinical judgment as well as provide neuroscientific insight. We used geometric distances to determine copositivity between preoperative data and intraoperative data. Twenty-eight patients were included who underwent both preoperative fMRI and TMS procedures, as well as an awake craniotomy and intraoperative language mapping. We found that TMS shows significantly superior correlation to intraoperative DCS compared with fMRI. TMS also showed significantly higher sensitivity and negative predictive value than specificity and positive predictive value. Poor cognitive baseline was associated with decreased TMS accuracy as well as increased risk for worsened aphasia postoperatively. TMS has emerged as a promising preoperative language mapping tool. Future work should be done to identify the proper role of each imaging modality in a comprehensive, multimodal approach to optimize the oncofunctional balance.
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Affiliation(s)
- Matthew Muir
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Rajan Patel
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, United States
| | - Jeffrey Traylor
- Department of Neurological Surgery, The University of Texas Southwestern Medical Center, Dallas, TX, United States
| | | | - Sarah Prinsloo
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Ho-Ling Liu
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Kyle Noll
- Department of Neuropsychology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Jeffrey Wefel
- Department of Neuropsychology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Sudhakar Tummala
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Vinodh Kumar
- Department of Neuroradiology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Sujit Prabhu
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
- *Correspondence: Sujit Prabhu,
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4
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Maurer S, Butenschoen VM, Meyer B, Krieg SM. Non-invasive mapping of cortical categorization function by repetitive navigated transcranial magnetic stimulation. Sci Rep 2021; 11:24480. [PMID: 34966169 PMCID: PMC8716524 DOI: 10.1038/s41598-021-04071-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Accepted: 12/08/2021] [Indexed: 12/04/2022] Open
Abstract
Over the past years navigated repetitive transcranial magnetic stimulation (nrTMS) had become increasingly important for the preoperative examination and mapping of eloquent brain areas. Among other applications it was demonstrated that the detection of neuropsychological function, such as arithmetic processing or face recognition, is feasible with nrTMS. In order to investigate the mapping of further brain functions, this study aims to investigate the cortical mapping of categorization function via nrTMS. 20 healthy volunteers purely right-handed, with German as mother tongue underwent nrTMS mapping using 5 Hz/10 pulses. 52 cortical spots spread over each hemisphere were stimulated. The task consisted of 80 pictures of living and non-living images, which the volunteers were instructed to categorize while the simulation pulses were applied. The highest error rates for all errors of all subjects were observed in the left hemisphere’s posterior middle frontal gyrus (pMFG) with an error rate of 60%, as well as in the right pMFG and posterior supra marginal gyrus (pSMG) (45%). In total the task processing of non-living objects elicited more errors in total, than the recognition of living objects. nrTMS is able to detect cortical categorization function. Moreover, the observed bihemispheric representation, as well as the higher error incidence for the recognition of non-living objects is well in accordance with current literature. Clinical applicability for preoperative mapping in brain tumor patients but also in general neuroscience has to be evaluated as the next step.
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Affiliation(s)
- Stefanie Maurer
- Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Ismaningerstr. 22, 81675, Munich, Germany.,TUM-Neuroimaging Center, Klinikum rechts der Isar, School of Medicine, Technische Universität München, Ismaningerstr. 22, 81675, Munich, Germany
| | - Vicki Marie Butenschoen
- Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Ismaningerstr. 22, 81675, Munich, Germany.,TUM-Neuroimaging Center, Klinikum rechts der Isar, School of Medicine, Technische Universität München, Ismaningerstr. 22, 81675, Munich, Germany
| | - Bernhard Meyer
- Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Ismaningerstr. 22, 81675, Munich, Germany.,TUM-Neuroimaging Center, Klinikum rechts der Isar, School of Medicine, Technische Universität München, Ismaningerstr. 22, 81675, Munich, Germany
| | - Sandro M Krieg
- Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Ismaningerstr. 22, 81675, Munich, Germany. .,TUM-Neuroimaging Center, Klinikum rechts der Isar, School of Medicine, Technische Universität München, Ismaningerstr. 22, 81675, Munich, Germany.
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5
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Dmitriev AY, Dashyan VG. [Functional magnetic resonance imaging in neurosurgery]. Zh Nevrol Psikhiatr Im S S Korsakova 2021; 121:138-143. [PMID: 34874669 DOI: 10.17116/jnevro2021121101138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The study is a short review of articles concerning functional magnetic resonance imaging (fMRI) and its practical application in neurosurgery. Advantages and disadvantages of the methods are considered, the results of surgical treatment of patients using functional navigation are presented. Separate attention is paid to fMRI precision, a new resting-state method of visualization. Practical advices of fMRI application in neurooncology and surgery of arteriovenous malformations are given.
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Affiliation(s)
- A Yu Dmitriev
- Sklifosovsky Research Institute for Emergency, Moscow, Russia.,Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
| | - V G Dashyan
- Sklifosovsky Research Institute for Emergency, Moscow, Russia.,Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
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6
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Dmitriev AY, Dashyan VG. [Functional magnetic resonance imaging in neurosurgery]. Zh Nevrol Psikhiatr Im S S Korsakova 2021; 121:118-123. [PMID: 34460167 DOI: 10.17116/jnevro2021121071118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The review of publications on functional magnetic resonance imaging (fMRI) and its practical application in neurosurgery is presented. Advantages and disadvantages are selected taking pathogenesis into account. Results of surgical treatment with use of functional navigation are described. Separate attention is paid to fMRI precision by its comparing with direct cortical stimulation. New resting-state method of visualization is observed. Practical advices are given of fMRI application in neurooncology and surgery of arteriovenous malformations.
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Affiliation(s)
- A Yu Dmitriev
- Sklifosovsky Research Institute for Emergency, Moscow, Russia.,Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
| | - V G Dashyan
- Sklifosovsky Research Institute for Emergency, Moscow, Russia.,Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
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7
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Hazem SR, Awan M, Lavrador JP, Patel S, Wren HM, Lucena O, Semedo C, Irzan H, Melbourne A, Ourselin S, Shapey J, Kailaya-Vasan A, Gullan R, Ashkan K, Bhangoo R, Vergani F. Middle Frontal Gyrus and Area 55b: Perioperative Mapping and Language Outcomes. Front Neurol 2021; 12:646075. [PMID: 33776898 PMCID: PMC7988187 DOI: 10.3389/fneur.2021.646075] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 01/29/2021] [Indexed: 12/20/2022] Open
Abstract
Background: The simplistic approaches to language circuits are continuously challenged by new findings in brain structure and connectivity. The posterior middle frontal gyrus and area 55b (pFMG/area55b), in particular, has gained a renewed interest in the overall language network. Methods: This is a retrospective single-center cohort study of patients who have undergone awake craniotomy for tumor resection. Navigated transcranial magnetic simulation (nTMS), tractography, and intraoperative findings were correlated with language outcomes. Results: Sixty-five awake craniotomies were performed between 2012 and 2020, and 24 patients were included. nTMS elicited 42 positive responses, 76.2% in the inferior frontal gyrus (IFG), and hesitation was the most common error (71.4%). In the pMFG/area55b, there were seven positive errors (five hesitations and two phonemic errors). This area had the highest positive predictive value (43.0%), negative predictive value (98.3%), sensitivity (50.0%), and specificity (99.0%) among all the frontal gyri. Intraoperatively, there were 33 cortical positive responses—two (6.0%) in the superior frontal gyrus (SFG), 15 (45.5%) in the MFG, and 16 (48.5%) in the IFG. A total of 29 subcortical positive responses were elicited−21 in the deep IFG–MFG gyri and eight in the deep SFG–MFG gyri. The most common errors identified were speech arrest at the cortical level (20 responses−13 in the IFG and seven in the MFG) and anomia at the subcortical level (nine patients—eight in the deep IFG–MFG and one in the deep MFG–SFG). Moreover, 83.3% of patients had a transitory deterioration of language after surgery, mainly in the expressive component (p = 0.03). An increased number of gyri with intraoperative positive responses were related with better preoperative (p = 0.037) and worse postoperative (p = 0.029) outcomes. The involvement of the SFG–MFG subcortical area was related with worse language outcomes (p = 0.037). Positive nTMS mapping in the IFG was associated with a better preoperative language outcome (p = 0.017), relating to a better performance in the expressive component, while positive mapping in the MFG was related to a worse preoperative receptive component of language (p = 0.031). Conclusion: This case series suggests that the posterior middle frontal gyrus, including area 55b, is an important integration cortical hub for both dorsal and ventral streams of language.
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Affiliation(s)
- Sally Rosario Hazem
- Department of Neurosurgery, King's College Hospital National Health Service Foundation Trust, London, United Kingdom.,King's Neuro Lab, Department of Neurosurgery, King's College Hospital National Health Service Foundation Trust, London, United Kingdom
| | - Mariam Awan
- Department of Neurosurgery, King's College Hospital National Health Service Foundation Trust, London, United Kingdom.,King's Neuro Lab, Department of Neurosurgery, King's College Hospital National Health Service Foundation Trust, London, United Kingdom
| | - Jose Pedro Lavrador
- Department of Neurosurgery, King's College Hospital National Health Service Foundation Trust, London, United Kingdom.,King's Neuro Lab, Department of Neurosurgery, King's College Hospital National Health Service Foundation Trust, London, United Kingdom
| | - Sabina Patel
- Department of Neurosurgery, King's College Hospital National Health Service Foundation Trust, London, United Kingdom.,King's Neuro Lab, Department of Neurosurgery, King's College Hospital National Health Service Foundation Trust, London, United Kingdom
| | - Hilary Margaret Wren
- Department of Neurosurgery, King's College Hospital National Health Service Foundation Trust, London, United Kingdom
| | - Oeslle Lucena
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Carla Semedo
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom.,Department of Medical Physics and Biomedical Engineering, University College London, London, United Kingdom
| | - Hassna Irzan
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom.,Department of Medical Physics and Biomedical Engineering, University College London, London, United Kingdom
| | - Andrew Melbourne
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom.,Department of Medical Physics and Biomedical Engineering, University College London, London, United Kingdom
| | - Sebastien Ourselin
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Jonathan Shapey
- Department of Neurosurgery, King's College Hospital National Health Service Foundation Trust, London, United Kingdom.,King's Neuro Lab, Department of Neurosurgery, King's College Hospital National Health Service Foundation Trust, London, United Kingdom.,School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Ahilan Kailaya-Vasan
- Department of Neurosurgery, King's College Hospital National Health Service Foundation Trust, London, United Kingdom.,King's Neuro Lab, Department of Neurosurgery, King's College Hospital National Health Service Foundation Trust, London, United Kingdom
| | - Richard Gullan
- Department of Neurosurgery, King's College Hospital National Health Service Foundation Trust, London, United Kingdom
| | - Keyoumars Ashkan
- Department of Neurosurgery, King's College Hospital National Health Service Foundation Trust, London, United Kingdom.,King's Neuro Lab, Department of Neurosurgery, King's College Hospital National Health Service Foundation Trust, London, United Kingdom
| | - Ranjeev Bhangoo
- Department of Neurosurgery, King's College Hospital National Health Service Foundation Trust, London, United Kingdom.,King's Neuro Lab, Department of Neurosurgery, King's College Hospital National Health Service Foundation Trust, London, United Kingdom
| | - Francesco Vergani
- Department of Neurosurgery, King's College Hospital National Health Service Foundation Trust, London, United Kingdom.,King's Neuro Lab, Department of Neurosurgery, King's College Hospital National Health Service Foundation Trust, London, United Kingdom
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8
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El Ouardi L. The Moroccan Arabic verb and noun test for language mapping (MAVNT-LP) under nTMS and DES. APPLIED NEUROPSYCHOLOGY-ADULT 2021; 29:1413-1424. [PMID: 33689513 DOI: 10.1080/23279095.2021.1883020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
To maximize tumor resection and minimize postoperative neurological sequelae, intraoperative Direct Electrical Stimulation (DES) coupled with preoperative Navigated Transcranial Magnetic Stimulation (nTMS) is adopted as a more valid procedure when a tumor is located in or near language-positive cortical and subcortical brain areas/networks. To map language functions peri- and intraoperatively, naming tasks are usually administered given their sensitivity and practicality in mapping language networks and their association with positive postoperative outcomes. Linguistic protocols designed for stimulation under nTMS are relatively scarce, and non-existent in the Arabic language. The present study attempts to fill these gaps by presenting the processes of development, piloting, and standardization of the first (Moroccan) Arabic object and action naming protocol for use preoperatively under nTMS, and intraoperatively under DES. The MAVNT-LP was developed in accordance with both DES and nTMS time requirements and was balanced for relevant psycholinguistic as well as intrinsic factors. The test underwent piloting on a population of 10 Moroccan Arabic (MA)-speaking individuals and was validated on a population of 50 participants. The standardized version of the test consisted of 61 nouns and 61 verbs. The 122 items included in the test were named accurately by at least 80% of the participants and had a high naming agreement. Correlations between psycholinguistic factors and lexical retrieval are reported and discussed. The MAVNT-LP was found to be a valid instrument for use in a clinical setting either as a planning tool or as a protocol used to stimulate eloquent brain areas under awake brain surgery.
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Affiliation(s)
- Loubna El Ouardi
- Applied Language and Culture Studies Lab, Chouaib Doukalli University, El Jadida, Morocco
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9
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Sollmann N, Fratini A, Zhang H, Zimmer C, Meyer B, Krieg SM. Associations between clinical outcome and tractography based on navigated transcranial magnetic stimulation in patients with language-eloquent brain lesions. J Neurosurg 2020; 132:1033-1042. [PMID: 30875686 DOI: 10.3171/2018.12.jns182988] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 12/06/2018] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Navigated transcranial magnetic stimulation (nTMS) in combination with diffusion tensor imaging fiber tracking (DTI FT) is increasingly used to locate subcortical language-related pathways. The aim of this study was to establish nTMS-based DTI FT for preoperative risk stratification by evaluating associations between lesion-to-tract distances (LTDs) and aphasia and by determining a cut-off LTD value to prevent surgery-related permanent aphasia. METHODS Fifty patients with left-hemispheric, language-eloquent brain tumors underwent preoperative nTMS language mapping and nTMS-based DTI FT, followed by tumor resection. nTMS-based DTI FT was performed with a predefined fractional anisotropy (FA) of 0.10, 0.15, 50% of the individual FA threshold (FAT), and 75% FAT (minimum fiber length [FL]: 100 mm). The arcuate fascicle (AF), superior longitudinal fascicle (SLF), inferior longitudinal fascicle (ILF), uncinate fascicle (UC), and frontooccipital fascicle (FoF) were identified in nTMS-based tractography, and minimum LTDs were measured between the lesion and the AF and between the lesion and the closest other subcortical language-related pathway (SLF, ILF, UC, or FoF). LTDs were then associated with the level of aphasia (no/transient or permanent surgery-related aphasia, according to follow-up examinations). RESULTS A significant difference in LTDs was observed between patients with no or only surgery-related transient impairment and those who developed surgery-related permanent aphasia with regard to the AF (FA = 0.10, p = 0.0321; FA = 0.15, p = 0.0143; FA = 50% FAT, p = 0.0106) as well as the closest other subcortical language-related pathway (FA = 0.10, p = 0.0182; FA = 0.15, p = 0.0200; FA = 50% FAT, p = 0.0077). Patients with surgery-related permanent aphasia showed the lowest LTDs in relation to these tracts. Thus, LTDs of ≥ 8 mm (AF) and ≥ 11 mm (SLF, ILF, UC, or FoF) were determined as cut-off values for surgery-related permanent aphasia. CONCLUSIONS nTMS-based DTI FT of subcortical language-related pathways seems suitable for risk stratification and prediction in patients suffering from language-eloquent brain tumors. Thus, the current role of nTMS-based DTI FT might be expanded, going beyond the level of being a mere tool for surgical planning and resection guidance.
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Affiliation(s)
- Nico Sollmann
- Departments of1Diagnostic and Interventional Neuroradiology and
- 2Neurosurgery and
- 3TUM-Neuroimaging Center, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | | | | | - Claus Zimmer
- Departments of1Diagnostic and Interventional Neuroradiology and
- 3TUM-Neuroimaging Center, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | | | - Sandro M Krieg
- 2Neurosurgery and
- 3TUM-Neuroimaging Center, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
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10
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Rejnö-Habte Selassie G, Pegenius G, Karlsson T, Viggedal G, Hallböök T, Elam M. Cortical mapping of receptive language processing in children using navigated transcranial magnetic stimulation. Epilepsy Behav 2020; 103:106836. [PMID: 31839497 DOI: 10.1016/j.yebeh.2019.106836] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 11/25/2019] [Accepted: 11/25/2019] [Indexed: 10/25/2022]
Abstract
We used a stepwise process to develop a new paradigm for preoperative cortical mapping of receptive language in children, using temporary functional blocking with transcranial magnetic stimulation (TMS). The method combines short sentences with a lexical decision task in which children are asked to point at a picture that fits a short sentence delivered aurally. This was first tested with 24 healthy children aged 4-16 years. Next, 75 sentences and 25 slides were presented to five healthy children in a clinical setting without TMS. Responses were registered on a separate computer, and facial expressions and hand movements were filmed for later offline review. Technical adjustments were made to combine these elements with the existing TMS equipment. The audio-recorded sentences were presented before the visual stimuli. Sentence lists were constructed to avoid similar stimuli in a row. Two different baseline lists were used before the TMS registration; the second baseline resulted in faster responses and was chosen as the reference for possible response delays induced by TMS. Protocols for offline reviews were constructed. No response, incorrect response, self-correction, delayed response, and perseveration were considered clear stimulation effects, while poor attention, discomfort, and other events were regarded as unclear. Finally, three children (6:2, 14:0, 14:10 years) with epilepsy and expected to undergo neurosurgery were assessed using TMS (left hemisphere in one; both hemispheres in the other two). In the two assessed bilaterally, TMS effects indicated bilateral language processing. Delayed response was the most common error. This is a first attempt to develop a new TMS paradigm for receptive language mapping, and further evaluation is suggested.
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Affiliation(s)
| | - Göran Pegenius
- Unit of Clinical Neurophysiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Tomas Karlsson
- Institute of Neuroscience & Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Gerd Viggedal
- Department of Pediatrics, Queen Silvia Children's Hospital and Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Tove Hallböök
- Department of Pediatrics, Queen Silvia Children's Hospital and Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Mikael Elam
- Unit of Clinical Neurophysiology, Sahlgrenska University Hospital, Gothenburg, Sweden; Institute of Neuroscience & Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden
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11
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Raffa G, Quattropani MC, Germanò A. When imaging meets neurophysiology: the value of navigated transcranial magnetic stimulation for preoperative neurophysiological mapping prior to brain tumor surgery. Neurosurg Focus 2019; 47:E10. [DOI: 10.3171/2019.9.focus19640] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 09/04/2019] [Indexed: 11/06/2022]
Abstract
Maximal safe resection is the modern goal for surgery of intrinsic brain tumors located in or close to brain eloquent areas. Nowadays different neuroimaging techniques provide important anatomical and functional information regarding the brain functional organization that can be used to plan a customized surgical strategy to preserve functional networks, and to increase the extent of tumor resection. Among these techniques, navigated transcranial magnetic stimulation (nTMS) has recently gained great favor among the neurosurgical community for preoperative mapping and planning prior to brain tumor surgery. It represents an advanced neuroimaging technique based on the neurophysiological mapping of the functional cortical brain organization. Moreover, it can be combined with other neuroimaging techniques such as diffusion tensor imaging tractography, thus providing a reliable reconstruction of brain eloquent networks. Consequently, nTMS mapping may provide reliable noninvasive brain functional mapping, anticipating information that otherwise may be available to neurosurgeons only in the operating theater by using direct electrical stimulation. The authors describe the reliability and usefulness of the preoperative nTMS-based approach in neurosurgical practice, and briefly discuss their experience using nTMS as well as currently available evidence in the literature supporting its clinical use. In particular, special attention is reserved for the discussion of the role of nTMS as a novel tool for the preoperative neurophysiological mapping of motor and language networks prior to surgery of intrinsic brain tumors located in or close to eloquent networks, as well as for future and promising applications of nTMS in neurosurgical practice.
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Affiliation(s)
- Giovanni Raffa
- 1Division of Neurosurgery, BIOMORF Department, University of Messina, Italy; and
| | | | - Antonino Germanò
- 1Division of Neurosurgery, BIOMORF Department, University of Messina, Italy; and
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12
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Sollmann N, Kelm A, Ille S, Schröder A, Zimmer C, Ringel F, Meyer B, Krieg SM. Setup presentation and clinical outcome analysis of treating highly language-eloquent gliomas via preoperative navigated transcranial magnetic stimulation and tractography. Neurosurg Focus 2019; 44:E2. [PMID: 29852769 DOI: 10.3171/2018.3.focus1838] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Awake surgery combined with intraoperative direct electrical stimulation (DES) and intraoperative neuromonitoring (IONM) is considered the gold standard for the resection of highly language-eloquent brain tumors. Different modalities, such as functional magnetic resonance imaging (fMRI) or magnetoencephalography (MEG), are commonly added as adjuncts for preoperative language mapping but have been shown to have relevant limitations. Thus, this study presents a novel multimodal setup consisting of preoperative navigated transcranial magnetic stimulation (nTMS) and nTMS-based diffusion tensor imaging fiber tracking (DTI FT) as an adjunct to awake surgery. METHODS Sixty consecutive patients (63.3% men, mean age 47.6 ± 13.3 years) suffering from highly language-eloquent left-hemispheric low- or high-grade glioma underwent preoperative nTMS language mapping and nTMS-based DTI FT, followed by awake surgery for tumor resection. Both nTMS language mapping and DTI FT data were available for resection planning and intraoperative guidance. Clinical outcome parameters, including craniotomy size, extent of resection (EOR), language deficits at different time points, Karnofsky Performance Scale (KPS) score, duration of surgery, and inpatient stay, were assessed. RESULTS According to postoperative evaluation, 28.3% of patients showed tumor residuals, whereas new surgery-related permanent language deficits occurred in 8.3% of patients. KPS scores remained unchanged (median preoperative score 90, median follow-up score 90). CONCLUSIONS This is the first study to present a clinical outcome analysis of this very modern approach, which is increasingly applied in neurooncological centers worldwide. Although human language function is a highly complex and dynamic cortico-subcortical network, the presented approach offers excellent functional and oncological outcomes in patients undergoing surgery of lesions affecting this network.
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Affiliation(s)
- Nico Sollmann
- 1Department of Diagnostic and Interventional Neuroradiology.,3TUM-Neuroimaging Center, Klinikum rechts der Isar, Technische Universität München, Germany
| | - Anna Kelm
- 2Department of Neurosurgery, and.,3TUM-Neuroimaging Center, Klinikum rechts der Isar, Technische Universität München, Germany
| | - Sebastian Ille
- 2Department of Neurosurgery, and.,3TUM-Neuroimaging Center, Klinikum rechts der Isar, Technische Universität München, Germany
| | | | - Claus Zimmer
- 1Department of Diagnostic and Interventional Neuroradiology.,3TUM-Neuroimaging Center, Klinikum rechts der Isar, Technische Universität München, Germany
| | | | | | - Sandro M Krieg
- 2Department of Neurosurgery, and.,3TUM-Neuroimaging Center, Klinikum rechts der Isar, Technische Universität München, Germany
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13
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Rejnö-Habte Selassie G, Pegenius G, Viggedal G, Hallböök T, Thordstein M. Navigated transcranial magnetic stimulation for preoperative cortical mapping of expressive language in children: Development of a method. Epilepsy Behav 2018; 87:180-187. [PMID: 30093270 DOI: 10.1016/j.yebeh.2018.05.036] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 05/20/2018] [Accepted: 05/20/2018] [Indexed: 12/16/2022]
Abstract
We adjusted an object-naming task with repetitive navigated transcranial magnetic stimulation (rnTMS) originally developed for preoperative cortical language mapping in adults in order for it to be used in children. Two series of pictures were chosen for children above and below 10 years of age, respectively. Firstly, the series of pictures and the preferred speed of presentation were assessed for their applicability in children of different ages and abilities. Secondly, these series were used with rnTMS preoperatively in five children with epilepsy. Naming errors induced by the stimulation comprised no response, delayed response, semantic error, phonological error, and self-correction. Language laterality was compared with the results of a dichotic listening test and with neuropsychological tests with respect to general laterality, and general language abilities were considered with respect to the results of stimulation. One participant had below normal general language abilities, two had below-normal rapid naming, and three had slow and indistinct articulation. Laterality was only clear in two of the participants. All children required breaks of various durations during the process, and individual adjustments of the interpicture interval and other stimulation parameters were also made. We conclude that, after adjustment, rnTMS combined with an object-naming task can be useful for preoperative language mapping in children.
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Affiliation(s)
| | - Göran Pegenius
- Unit of Clinical Neurophysiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Gerd Viggedal
- Department of Pediatrics, Queen Silvia Children's Hospital and Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Tove Hallböök
- Department of Pediatrics, Queen Silvia Children's Hospital and Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Magnus Thordstein
- Unit of Clinical Neurophysiology, Sahlgrenska University Hospital, Gothenburg, Sweden
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14
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Functional brain mapping: overview of techniques and their application to neurosurgery. Neurosurg Rev 2018; 42:639-647. [DOI: 10.1007/s10143-018-1007-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 06/25/2018] [Accepted: 07/06/2018] [Indexed: 10/28/2022]
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15
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Language function shows comparable cortical patterns by functional MRI and repetitive nTMS in healthy volunteers. Brain Imaging Behav 2018; 13:1071-1092. [DOI: 10.1007/s11682-018-9921-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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16
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Visualization of subcortical language pathways by diffusion tensor imaging fiber tracking based on rTMS language mapping. Brain Imaging Behav 2018; 11:899-914. [PMID: 27323766 DOI: 10.1007/s11682-016-9563-0] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Diffusion tensor imaging fiber tracking (DTI FT) is used to visualize subcortical fiber tracts. Yet, there is no standard at hand to visualize language-involved subcortical fibers reliably. Thus, this study investigates the feasibility of using language-related cortical areas identified via repetitive navigated transcranial magnetic stimulation (rTMS) to seed DTI FT of subcortical language tracts. From 2011 to 2014, 37 patients with left-hemispheric perisylvian lesions were examined. Language-positive rTMS stimulation spots were integrated in the deterministic tractography software (BrainLAB, iPlanNet 3.0) as objects and used as seed regions for DTI FT. Tractography was then performed in each patient with 77 different combinations of fiber lengths (40 - 100 mm) and fractional anisotropy (FA; 0.01 - 0.5). The rTMS-based DTI FT identified all commonly known subcortical language tracts, such as the corticonuclear tract, arcuate fascicle, uncinate fascicle, superior longitudinal fascicle, inferior longitudinal fascicle, arcuate fibers, commissural fibers, corticothalamic fibers, and the fronto-occipital fascicle. In 32 patients (86.5 %), each above-named tract could be visualized, while at least 6 out of these 9 tracts were identified in each patient. A fiber length of 100 mm and an FA of 0.1 or 0.15 provided optimal visualization by revealing 125 and 61 individually tracked fibers per visualized language tract and 90 % and 73 % of all language-related tracts, respectively. This study proves the feasibility of rTMS-based DTI FT for subcortical language tracts, provides suitable settings, and shows its easy and standardizable application for the visualization of every language tract in 86.5 % of patients.
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Ille S, Drummer K, Giglhuber K, Conway N, Maurer S, Meyer B, Krieg SM. Mapping of Arithmetic Processing by Navigated Repetitive Transcranial Magnetic Stimulation in Patients with Parietal Brain Tumors and Correlation with Postoperative Outcome. World Neurosurg 2018; 114:e1016-e1030. [PMID: 29597021 DOI: 10.1016/j.wneu.2018.03.136] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Revised: 03/18/2018] [Accepted: 03/19/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND Preserving functionality is important during neurosurgical resection of brain tumors. Specialized centers also map further brain functions apart from motor and language functions, such as arithmetic processing (AP). The mapping of AP by navigated repetitive transcranial magnetic stimulation (nrTMS) in healthy volunteers has been reported. OBJECTIVE The present study aimed to correlate the results of mapping AP with functional patient outcomes. METHODS We included 26 patients with parietal brain tumors. Because of preoperative impairment of AP, mapping was not possible in 8 patients (31%). We stimulated 52 cortical sites by nrTMS while patients performed a calculation task. Preoperatively and postoperatively, patients underwent a standardized number-processing and calculation test (NPCT). Tumor resection was blinded to nrTMS results, and the change in NPCT performance was correlated to resected AP-positive spots as identified by nrTMS. RESULTS The resection of AP-positive sites correlated with a worsening of the postoperative NPCT result in 12 cases. In 3 cases, no AP-positive sites were resected and the postoperative NPCT result was similar to or better than preoperatively. Also, in 3 cases, the postoperative NPCT result was better than preoperatively, although AP-positive sites were resected. CONCLUSIONS Despite presenting only a few cases, nrTMS might be a useful tool for preoperative mapping of AP. However, the reliability of the present results has to be evaluated in a larger series and by intraoperative mapping data.
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Affiliation(s)
- Sebastian Ille
- Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany; TUM Neuroimaging Center, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Katharina Drummer
- Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany; TUM Neuroimaging Center, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Katrin Giglhuber
- Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany; TUM Neuroimaging Center, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Neal Conway
- Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany; TUM Neuroimaging Center, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Stefanie Maurer
- Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany; TUM Neuroimaging Center, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Bernhard Meyer
- Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Sandro M Krieg
- Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany; TUM Neuroimaging Center, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
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18
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Negwer C, Beurskens E, Sollmann N, Maurer S, Ille S, Giglhuber K, Kirschke JS, Ringel F, Meyer B, Krieg SM. Loss of Subcortical Language Pathways Correlates with Surgery-Related Aphasia in Patients with Brain Tumor: An Investigation via Repetitive Navigated Transcranial Magnetic Stimulation–Based Diffusion Tensor Imaging Fiber Tracking. World Neurosurg 2018; 111:e806-e818. [DOI: 10.1016/j.wneu.2017.12.163] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 12/23/2017] [Accepted: 12/27/2017] [Indexed: 11/26/2022]
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The impact of nTMS mapping on treatment of brain AVMs. Acta Neurochir (Wien) 2018; 160:567-578. [PMID: 29368047 DOI: 10.1007/s00701-018-3475-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 01/16/2018] [Indexed: 10/18/2022]
Abstract
BACKGROUND The treatment of brain arteriovenous malformations (BAVMs) is still contrarily discussed. Despite the debatable results of the ARUBA trial, most BAVMs still require treatment depending on the Spetzler-Martin (SM) grading. Since size is measurable and venous drainage is visible, the determination of eloquence is comparably crucial but not fully objective. The present bicentric cohort study aims to examine the influence of preoperative navigated transcranial magnetic stimulation (nTMS) motor and language mapping data on decision-making for or against surgical treatment of BAVMs. METHODS The influence of data from nTMS on decision-making for or against treatment of BAVMs was examined by confirming/falsifying presumed motor or language eloquence. RESULTS The results of nTMS mappings changed the SM grading in nine cases. In six cases, the SM grading changed to a lower grade (= falsified eloquence); in three cases, the SM grading changed to a higher grade due to nTMS mappings (= unexpected eloquence). Out of all 34 cases, indication for surgery was supported by nTMS mappings in 15 cases (7 motors, 8 languages). In six cases, the decision against surgery was made based on nTMS mappings (three motors, three languages). CONCLUSION In 21 of 34 cases (62%), nTMS was a supportive argument. We could show that nTMS motor and language data can be used for a more objective decision-making regarding the treatment of BAVMs and for a more detailed SM grading regarding the rating of eloquence.
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Babajani-Feremi A, Holder CM, Narayana S, Fulton SP, Choudhri AF, Boop FA, Wheless JW. Predicting postoperative language outcome using presurgical fMRI, MEG, TMS, and high gamma ECoG. Clin Neurophysiol 2018; 129:560-571. [PMID: 29414401 DOI: 10.1016/j.clinph.2017.12.031] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Revised: 11/17/2017] [Accepted: 12/05/2017] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To predict the postoperative language outcome using the support vector regression (SVR) and results of multimodal presurgical language mapping. METHODS Eleven patients with epilepsy received presurgical language mapping using functional MRI (fMRI), magnetoencephalography (MEG), transcranial magnetic stimulation (TMS), and high-gamma electrocorticography (hgECoG), as well as pre- and postoperative neuropsychological evaluation of language. We constructed 15 (24-1) SVR models by considering the extent of resected language areas identified by all subsets of four modalities as input feature vector and the postoperative language outcome as output. We trained and cross-validated SVR models, and compared the cross-validation (CV) errors of all models for prediction of language outcome. RESULTS Seven patients had some level of postoperative language decline and two of them had significant postoperative decline in naming. Some parts of language areas identified by four modalities were resected in these patients. We found that an SVR model consisting of fMRI, MEG, and hgECoG provided minimum CV error, although an SVR model consisting of fMRI and MEG was the optimal model that facilitated the best trade-off between model complexity and prediction accuracy. CONCLUSIONS A multimodal SVR can be used to predict the language outcome. SIGNIFICANCE The developed multimodal SVR models in this study can be utilized to calculate the language outcomes of different resection plans prior to surgery and select the optimal surgical plan.
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Affiliation(s)
- Abbas Babajani-Feremi
- University of Tennessee Health Science Center, Department of Pediatrics and Department of Anatomy and Neurobiology, Le Bonheur Children's Hospital, Neuroscience Institute, Memphis, TN, USA.
| | - Christen M Holder
- University of Tennessee Health Science Center, Department of Pediatrics, Le Bonheur Children's Hospital, Neuroscience Institute, Memphis, TN, USA
| | - Shalini Narayana
- University of Tennessee Health Science Center, Department of Pediatrics and Department of Anatomy and Neurobiology, Le Bonheur Children's Hospital, Neuroscience Institute, Memphis, TN, USA
| | - Stephen P Fulton
- University of Tennessee Health Science Center, Department of Pediatrics, Le Bonheur Children's Hospital, Neuroscience Institute, Memphis, TN, USA
| | - Asim F Choudhri
- University of Tennessee Health Science Center, Department of Pediatrics, Le Bonheur Children's Hospital, Neuroscience Institute, Memphis, TN, USA
| | - Frederick A Boop
- University of Tennessee Health Science Center, Department of Pediatrics, Le Bonheur Children's Hospital, Neuroscience Institute, Memphis, TN, USA
| | - James W Wheless
- University of Tennessee Health Science Center, Department of Pediatrics, Le Bonheur Children's Hospital, Neuroscience Institute, Memphis, TN, USA
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dos Santos MD, Cavenaghi VB, Mac-Kay APMG, Serafim V, Venturi A, Truong DQ, Huang Y, Boggio PS, Fregni F, Simis M, Bikson M, Gagliardi RJ. Non-invasive brain stimulation and computational models in post-stroke aphasic patients: single session of transcranial magnetic stimulation and transcranial direct current stimulation. A randomized clinical trial. SAO PAULO MED J 2017; 135:475-480. [PMID: 29116303 PMCID: PMC10027244 DOI: 10.1590/1516-3180.2016.0194060617] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 06/06/2017] [Indexed: 11/22/2022] Open
Abstract
CONTEXT AND OBJECTIVE Patients undergoing the same neuromodulation protocol may present different responses. Computational models may help in understanding such differences. The aims of this study were, firstly, to compare the performance of aphasic patients in naming tasks before and after one session of transcranial direct current stimulation (tDCS), transcranial magnetic stimulation (TMS) and sham, and analyze the results between these neuromodulation techniques; and secondly, through computational model on the cortex and surrounding tissues, to assess current flow distribution and responses among patients who received tDCS and presented different levels of results from naming tasks. DESIGN AND SETTING Prospective, descriptive, qualitative and quantitative, double blind, randomized and placebo-controlled study conducted at Faculdade de Ciências Médicas da Santa Casa de São Paulo. METHODS Patients with aphasia received one session of tDCS, TMS or sham stimulation. The time taken to name pictures and the response time were evaluated before and after neuromodulation. Selected patients from the first intervention underwent a computational model stimulation procedure that simulated tDCS. RESULTS The results did not indicate any statistically significant differences from before to after the stimulation.The computational models showed different current flow distributions. CONCLUSIONS The present study did not show any statistically significant difference between tDCS, TMS and sham stimulation regarding naming tasks. The patients'responses to the computational model showed different patterns of current distribution.
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Affiliation(s)
- Michele Devido dos Santos
- PhD. Professor of Speech Pathology and Audiology, Faculdade de Ciências Médicas da Santa Casa de São Paulo (FCMSCSP), São Paulo (SP), Brazil.
| | - Vitor Breseghello Cavenaghi
- Medical Student, Faculdade de Ciências Médicas da Santa Casa de São Paulo (FCMSCSP), São Paulo (SP), Brazil.
| | | | - Vitor Serafim
- Medical Student, Faculdade de Ciências Médicas da Santa Casa de São Paulo (FCMSCSP), São Paulo (SP), Brazil.
| | - Alexandre Venturi
- Medical Student, Faculdade de Ciências Médicas da Santa Casa de São Paulo (FCMSCSP), São Paulo (SP), Brazil.
| | - Dennis Quangvinh Truong
- PhD. Biomedical Engineer, Engineering Department, City College of New York, New York, United States.
| | - Yu Huang
- PhD. Biomedical Engineer, Engineering Department, City College of New York, New York, United States.
| | - Paulo Sérgio Boggio
- BSc, PhD. Professor of Cognitive Neuroscience, Cognitive Neuroscience Laboratory, Mackenzie Presbyterian University, São Paulo (SP), Brazil.
| | - Felipe Fregni
- MD, PhD, MPH. Associate Professor of Physical Medicine & Rehabilitation, Associate Professor of Neurology, Harvard Medical School; Director Neuromodulation Center, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts, United States.
| | - Marcel Simis
- MD, PhD. Neurologist, Irmandade da Santa Casa de Misericórdia de São Paulo, and Instituto de Medicina Física e Reabilitação (IMREA), Hospital das Clínicas (HC), Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo (SP), Brazil.
| | - Marom Bikson
- PhD. Associate Professor of Biomedical Engineering, City College, City University of New York, New York, United States.
| | - Rubens José Gagliardi
- MD, PhD. Full Professor, Department of Neurology, Faculdade de Ciências Médicas da Santa Casa de São Paulo (FCMSCSP), São Paulo (SP), Brazil.
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Sollmann N, Meyer B, Krieg SM. Implementing Functional Preoperative Mapping in the Clinical Routine of a Neurosurgical Department: Technical Note. World Neurosurg 2017; 103:94-105. [PMID: 28377253 DOI: 10.1016/j.wneu.2017.03.114] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 03/22/2017] [Accepted: 03/23/2017] [Indexed: 01/01/2023]
Abstract
BACKGROUND Navigated transcranial magnetic stimulation (nTMS) is increasingly being used for mapping of various brain functions and in nTMS-based tractography in neurosurgical departments worldwide. When a department begins using nTMS data in the clinical workflow, smooth integration into the hospital's existing infrastructure is mandatory. Standardized approaches for this beyond the mapping or tractography procedures themselves have not yet been described. METHODS To create an effective workflow for neurosurgical nTMS mapping, we present the findings of our 7 years of experience and progressive integration into the clinical routine. RESULTS After indication for mapping is made, the workflow starts with patient admission and includes all preoperative steps until tumor resection. Importantly, only standard software and devices were used, enabling new centers to easily integrate data derived from nTMS mapping and nTMS-based tractography into their hospital's infrastructure. Registration of the patient, appointment planning, and documentation of results of the nTMS procedures within the hospital information system (HIS) can be achieved by a novel tailored software mask. As another important part of the workflow, nTMS data are imported into the picture archiving and communication system (PACS) via PACS integrator software. In addition, for surgical planning including nTMS-based tractography, nTMS data can be effectively included in surgical neuronavigation software. CONCLUSIONS Optimized integration of nTMS data can be achieved using a standardized workflow. The seamless integration and availability of nTMS data are crucial to the acceptance of these data in the clinical routine. This optimized workflow can serve as a guide for centers beginning to use nTMS data in patient care.
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Affiliation(s)
- Nico Sollmann
- Department of Neurosurgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; TUM Neuroimaging Center, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Bernhard Meyer
- Department of Neurosurgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Sandro M Krieg
- Department of Neurosurgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; TUM Neuroimaging Center, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.
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23
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Maurer S, Giglhuber K, Sollmann N, Kelm A, Ille S, Hauck T, Tanigawa N, Ringel F, Boeckh-Behrens T, Meyer B, Krieg SM. Non-invasive Mapping of Face Processing by Navigated Transcranial Magnetic Stimulation. Front Hum Neurosci 2017; 11:4. [PMID: 28167906 PMCID: PMC5253359 DOI: 10.3389/fnhum.2017.00004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 01/04/2017] [Indexed: 01/31/2023] Open
Abstract
Background: Besides motor and language function, tumor resections within the frontal and parietal lobe have also been reported to cause neuropsychological impairment like prosopagnosia. Objective: Since non-navigated transcranial magnetic stimulation (TMS) has previously been used to map neuropsychological cortical function, this study aims to evaluate the feasibility and spatial discrimination of repetitive navigated TMS (rTMS) mapping for detection of face processing impairment in healthy volunteers. The study was also designed to establish this examination for preoperative mapping in brain tumor patients. Methods: Twenty healthy and purely right-handed volunteers (11 female, 9 male) underwent rTMS mapping for cortical face processing function using 5 Hz/10 pulses. Both hemispheres were investigated randomly with an interval of 2 weeks between mapping sessions. Fifty-two predetermined cortical spots of the whole hemispheres were mapped after baseline measurement. The task consisted of 80 portraits of popular persons, which had to be named while rTMS was applied. Results: In 80% of all subjects rTMS elicited naming errors in the right middle middle frontal gyrus (mMFG). Concerning anomia errors, the highest error rate (35%) was achieved in the bilateral triangular inferior frontal gyrus (trIFG). With regard to similarly or wrongly named persons, we observed 10% error rates mainly in the bilateral frontal lobes. Conclusion: It seems feasible to map the cortical face processing function and to generate face processing impairment via rTMS. The observed localizations are well in accordance with the contemporary literature, and the mapping did not interfere with rTMS-induced language impairment. The clinical usefulness of preoperative mapping has to be evaluated subsequently.
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Affiliation(s)
- Stefanie Maurer
- Department of Neurosurgery, Klinikum Rechts der Isar, Technische Universität München Munich, Germany
| | - Katrin Giglhuber
- Department of Neurosurgery, Klinikum Rechts der Isar, Technische Universität München Munich, Germany
| | - Nico Sollmann
- Department of Neurosurgery, Klinikum Rechts der Isar, Technische Universität München Munich, Germany
| | - Anna Kelm
- Department of Neurosurgery, Klinikum Rechts der Isar, Technische Universität München Munich, Germany
| | - Sebastian Ille
- Department of Neurosurgery, Klinikum Rechts der Isar, Technische Universität München Munich, Germany
| | - Theresa Hauck
- Department of Neurosurgery, Klinikum Rechts der Isar, Technische Universität München Munich, Germany
| | - Noriko Tanigawa
- Faculty of Linguistics, Philology, and Phonetics, University of Oxford Oxford, UK
| | - Florian Ringel
- Department of Neurosurgery, Klinikum Rechts der Isar, Technische Universität München Munich, Germany
| | - Tobias Boeckh-Behrens
- Section of Neuroradiology, Department of Radiology, Klinikum Rechts der Isar, Technische Universität München Munich, Germany
| | - Bernhard Meyer
- Department of Neurosurgery, Klinikum Rechts der Isar, Technische Universität München Munich, Germany
| | - Sandro M Krieg
- Department of Neurosurgery, Klinikum Rechts der Isar, Technische Universität München Munich, Germany
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24
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Krieg SM, Picht T, Sollmann N, Bährend I, Ringel F, Nagarajan SS, Meyer B, Tarapore PE. Resection of Motor Eloquent Metastases Aided by Preoperative nTMS-Based Motor Maps-Comparison of Two Observational Cohorts. Front Oncol 2016; 6:261. [PMID: 28066717 PMCID: PMC5174728 DOI: 10.3389/fonc.2016.00261] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 12/08/2016] [Indexed: 11/13/2022] Open
Abstract
Introduction Preoperative mapping of motor areas with navigated transcranial magnetic stimulation (nTMS) has been shown to improve surgical outcomes for peri-Rolandic lesions and, in particular, for gliomas. However, the impact of this technique on surgical outcomes for peri-Rolandic metastatic lesions is yet unknown. Objective To investigate the impact of nTMS on surgical outcomes for peri-Rolandic metastatic lesions, various clinical parameters were analyzed in our international study group. Methods Two prospectively enrolled cohorts were compared by investigating patients receiving preoperative nTMS (2010–2015; 120 patients) and patients who did not receive preoperative nTMS (2006–2015; 130 patients). Tumor location, pathology, size, and preoperative deficits were comparable. Results The nTMS group showed a lower rate of residual tumor on postoperative magnetic resonance imaging (odds ratio 0.3025; 95% confidence interval 0.1356–0.6749). On long-term follow-up, surgery-related paresis was decreased in the nTMS group (nTMS vs. non-nTMS; improved: 30.8 vs. 13.1%, unchanged: 65.8 vs. 73.8%, worse: 3.4 vs. 13.1% of patients; p = 0.0002). Moreover, the nTMS group received smaller craniotomies (nTMS: 16.7 ± 8.6 cm2 vs. non-nTMS: 25.0 ± 17.1 cm2; p < 0.0001). Surgical time differed significantly between the two groups (nTMS: 128.8 ± 49.4 min vs. non-nTMS: 158.0 ± 65.8 min; p = 0.0002). Conclusion This non-randomized study suggests that preoperative motor mapping by nTMS may improve the treatment of patients undergoing surgical resection of metastases in peri-Rolandic regions. These findings suggest that further evaluation with a prospective, randomized trial may be warranted.
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Affiliation(s)
- Sandro M Krieg
- Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München , Munich , Germany
| | - Thomas Picht
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin , Berlin , Germany
| | - Nico Sollmann
- Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München , Munich , Germany
| | - Ina Bährend
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin , Berlin , Germany
| | - Florian Ringel
- Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München , Munich , Germany
| | - Srikantan S Nagarajan
- Biomagnetic Imaging Laboratory, Department of Radiology, University of California San Francisco , San Francisco, CA , USA
| | - Bernhard Meyer
- Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München , Munich , Germany
| | - Phiroz E Tarapore
- Department of Neurological Surgery, University of California San Francisco , San Francisco, CA , USA
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25
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Ille S, Sollmann N, Butenschoen VM, Meyer B, Ringel F, Krieg SM. Resection of highly language-eloquent brain lesions based purely on rTMS language mapping without awake surgery. Acta Neurochir (Wien) 2016; 158:2265-2275. [PMID: 27688208 DOI: 10.1007/s00701-016-2968-0] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2016] [Accepted: 09/12/2016] [Indexed: 12/31/2022]
Abstract
BACKGROUND The resection of left-sided perisylvian brain lesions harbours the risk of postoperative language impairment. Therefore the individual patient's language distribution is investigated by intraoperative direct cortical stimulation (DCS) during awake surgery. Yet, not all patients qualify for awake surgery. Non-invasive language mapping by repetitive navigated transcranial magnetic stimulation (rTMS) has frequently shown a high correlation in comparison with the results of DCS language mapping in terms of language-negative brain regions. The present study analyses the extent of resection (EOR) and functional outcome of patients who underwent left-sided perisylvian resection of brain lesions based purely on rTMS language mapping. METHODS Four patients with left-sided perisylvian brain lesions (two gliomas WHO III, one glioblastoma, one cavernous angioma) underwent rTMS language mapping prior to surgery. Data from rTMS language mapping and rTMS-based diffusion tensor imaging fibre tracking (DTI-FT) were transferred to the intraoperative neuronavigation system. Preoperatively, 5 days after surgery (POD5), and 3 months after surgery (POM3) clinical follow-up examinations were performed. RESULTS No patient suffered from a new surgery-related aphasia at POM3. Three patients underwent complete resection immediately, while one patient required a second rTMS-based resection some days later to achieve the final, complete resection. CONCLUSIONS The present study shows for the first time the feasibility of successfully resecting language-eloquent brain lesions based purely on the results of negative language maps provided by rTMS language mapping and rTMS-based DTI-FT. In very select cases, this technique can provide a rescue strategy with an optimal functional outcome and EOR when awake surgery is not feasible.
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Affiliation(s)
- Sebastian Ille
- Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany
- TUM Neuroimaging Center, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Nico Sollmann
- Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany
- TUM Neuroimaging Center, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Vicki M Butenschoen
- Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany
- TUM Neuroimaging Center, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Bernhard Meyer
- Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany
| | - Florian Ringel
- Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany
| | - Sandro M Krieg
- Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany.
- TUM Neuroimaging Center, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
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Ille S, Kulchytska N, Sollmann N, Wittig R, Beurskens E, Butenschoen VM, Ringel F, Vajkoczy P, Meyer B, Picht T, Krieg SM. Hemispheric language dominance measured by repetitive navigated transcranial magnetic stimulation and postoperative course of language function in brain tumor patients. Neuropsychologia 2016; 91:50-60. [DOI: 10.1016/j.neuropsychologia.2016.07.025] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2016] [Revised: 07/17/2016] [Accepted: 07/19/2016] [Indexed: 10/21/2022]
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Mapping of cortical language function by functional magnetic resonance imaging and repetitive navigated transcranial magnetic stimulation in 40 healthy subjects. Acta Neurochir (Wien) 2016; 158:1303-16. [PMID: 27138329 DOI: 10.1007/s00701-016-2819-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Accepted: 04/20/2016] [Indexed: 12/31/2022]
Abstract
BACKGROUND Functional magnetic resonance imaging (fMRI) is considered to be the standard method regarding non-invasive language mapping. However, repetitive navigated transcranial magnetic stimulation (rTMS) gains increasing importance with respect to that purpose. However, comparisons between both methods are sparse. METHODS We performed fMRI and rTMS language mapping of the left hemisphere in 40 healthy, right-handed subjects in combination with the tasks that are most commonly used in the neurosurgical context (fMRI: word-generation = WGEN task; rTMS: object-naming = ON task). Different rTMS error rate thresholds (ERTs) were calculated, and Cohen's kappa coefficient and the cortical parcellation system (CPS) were used for systematic comparison of the two techniques. RESULTS Overall, mean kappa coefficients were low, revealing no distinct agreement. We found the highest agreement for both techniques when using the 2-out-of-3 rule (CPS region defined as language positive in terms of rTMS if at least 2 out of 3 stimulations led to a naming error). However, kappa for this threshold was only 0.24 (kappa of <0, 0.01-0.20, 0.21-0.40, 0.41-0.60, 0.61-0.80 and 0.81-0.99 indicate less than chance, slight, fair, moderate, substantial and almost perfect agreement, respectively). CONCLUSIONS Because of the inherent differences in the underlying physiology of fMRI and rTMS, the different tasks used and the impossibility of verifying the results via direct cortical stimulation (DCS) in the population of healthy volunteers, one must exercise caution in drawing conclusions about the relative usefulness of each technique for language mapping. Nevertheless, this study yields valuable insights into these two mapping techniques for the most common language tasks currently used in neurosurgical practice.
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Negwer C, Sollmann N, Ille S, Hauck T, Maurer S, Kirschke JS, Ringel F, Meyer B, Krieg SM. Language pathway tracking: comparing nTMS-based DTI fiber tracking with a cubic ROIs-based protocol. J Neurosurg 2016; 126:1006-1014. [PMID: 27231977 DOI: 10.3171/2016.2.jns152382] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVE Diffusion tensor imaging (DTI) fiber tracking (FT) has been widely used in glioma surgery in recent years. It can provide helpful information about subcortical structures, especially in patients with eloquent space-occupying lesions. This study compared the newly developed navigated transcranial magnetic stimulation (nTMS)-based DTI FT of language pathways with the most reproducible protocol for language pathway tractography, using cubic regions of interest (ROIs) for the arcuate fascicle. METHODS Thirty-seven patients with left-sided perisylvian lesions underwent language mapping by repetitive nTMS. DTI FT was performed using the cubic ROIs-based protocol and the authors' nTMS-based DTI FT approach. The same minimal fiber length and fractional anisotropy were chosen (50 mm and 0.2, respectively). Both protocols were performed with standard clinical tractography software. RESULTS Both methods visualized language-related fiber tracts (i.e., corticonuclear tract, arcuate fascicle, uncinate fascicle, superior longitudinal fascicle, inferior longitudinal fascicle, arcuate fibers, commissural fibers, corticothalamic fibers, and frontooccipital fascicle) in all 37 patients. Using the cubic ROIs-based protocol, 39.9% of these language-related fiber tracts were detected in the examined patients, as opposed to 76.0% when performing nTMS-based DTI FT. For specifically tracking the arcuate fascicle, however, the cubic ROIs-based approach showed better results (97.3% vs 75.7% with nTMS-based DTI FT). CONCLUSIONS The cubic ROIs-based protocol was designed for arcuate fascicle tractography, and this study shows that it is still useful for this intention. However, superior results were obtained using the nTMS-based DTI FT for visualization of other language-related fiber tracts.
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Affiliation(s)
- Chiara Negwer
- Department of Neurosurgery.,TUM-Neuroimaging Center, and
| | - Nico Sollmann
- Department of Neurosurgery.,TUM-Neuroimaging Center, and
| | - Sebastian Ille
- Department of Neurosurgery.,TUM-Neuroimaging Center, and
| | - Theresa Hauck
- Department of Neurosurgery.,TUM-Neuroimaging Center, and
| | | | - Jan S Kirschke
- Section of Neuroradiology, Department of Radiology, Klinikum rechts der Isar, Technical University of Munich, Germany
| | | | | | - Sandro M Krieg
- Department of Neurosurgery.,TUM-Neuroimaging Center, and
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Sollmann N, Negwer C, Ille S, Maurer S, Hauck T, Kirschke JS, Ringel F, Meyer B, Krieg SM. Feasibility of nTMS-based DTI fiber tracking of language pathways in neurosurgical patients using a fractional anisotropy threshold. J Neurosci Methods 2016; 267:45-54. [PMID: 27059128 DOI: 10.1016/j.jneumeth.2016.04.002] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2016] [Revised: 03/31/2016] [Accepted: 04/04/2016] [Indexed: 12/14/2022]
Abstract
BACKGROUND Navigated transcranial magnetic stimulation (nTMS) provides language maps in brain tumor patients. Yet, corresponding data on the visualization of language-related subcortical pathways is lacking. Therefore, this study evaluates the feasibility of nTMS-based diffusion tensor imaging fiber tracking (DTI FT) for subcortical language pathways by a fractional anisotropy (FA) protocol. NEW METHOD DTI FT was performed in 37 patients suffering from left-sided perisylvian brain lesions based on nTMS data exclusively, using the FA-based protocol originally established for the corticospinal tract (CST) by Frey et al. (2012): minimum fiber length was 110mm and the highest individual FA value leading to visualization of white matter tracts was determined as the FA threshold (FAT). Then, deterministic DTI FT using an FA value of 100%, 75%, 50%, and 25% of the individual FAT (with 25% as an additional setting to the original protocol) was performed. RESULTS Our approach visualized 9 language-related subcortical white matter pathways. By using 100% FAT, the mean percentage of visualized tracts was 13.5%, whereas DTI FT performed with 75%, 50%, and 25% FAT detected 30.6%, 61.3%, and 93.7% of language-related fiber tracts, respectively. COMPARISON WITH EXISTING METHODS nTMS language mapping alone is not able to visualize subcortical language-related pathways. CONCLUSIONS This study shows that nTMS language maps are feasible for DTI FT of language-related pathways within the scope of a FAT-based protocol. Although this approach is novel and might be helpful during scientific neuroimaging and tumor resection, intraoperative validation is needed to go beyond the level of feasibility.
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Affiliation(s)
- Nico Sollmann
- Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675 Munich, Germany; TUM-Neuroimaging Center, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675 Munich, Germany.
| | - Chiara Negwer
- Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675 Munich, Germany.
| | - Sebastian Ille
- Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675 Munich, Germany; TUM-Neuroimaging Center, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675 Munich, Germany.
| | - Stefanie Maurer
- Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675 Munich, Germany; TUM-Neuroimaging Center, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675 Munich, Germany.
| | - Theresa Hauck
- Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675 Munich, Germany; TUM-Neuroimaging Center, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675 Munich, Germany.
| | - Jan S Kirschke
- Section of Neuroradiology, Department of Radiology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675 Munich, Germany.
| | - Florian Ringel
- Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675 Munich, Germany.
| | - Bernhard Meyer
- Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675 Munich, Germany.
| | - Sandro M Krieg
- Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675 Munich, Germany; TUM-Neuroimaging Center, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675 Munich, Germany.
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30
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Sollmann N, Negwer C, Tussis L, Hauck T, Ille S, Maurer S, Giglhuber K, Bauer JS, Ringel F, Meyer B, Krieg SM. Interhemispheric connectivity revealed by diffusion tensor imaging fiber tracking derived from navigated transcranial magnetic stimulation maps as a sign of language function at risk in patients with brain tumors. J Neurosurg 2016; 126:222-233. [PMID: 27035166 DOI: 10.3171/2016.1.jns152053] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Resection of brain tumors in language-eloquent areas entails the risk of postoperative aphasia. It has been demonstrated via navigated transcranial magnetic stimulation (nTMS) that language function can partially shift to the unaffected hemisphere due to tumor-induced plasticity. Therefore, this study was designed to evaluate whether interhemispheric connectivity (IC) detected by nTMS-based diffusion tensor imaging-fiber tracking (DTI-FT) can be used to predict surgery-related aphasia in patients with brain tumors. METHODS Thirty-eight patients with left-sided perisylvian brain lesions underwent cortical language mapping of both hemispheres by nTMS prior to awake surgery. Then, nTMS-based DTI-FT was conducted with a fractional anisotropy (FA) of 0.01 and 0.2 to visualize nTMS-based IC. Receiver operating characteristics were calculated for the prediction of a postoperative (irrespective of the preoperative state) and a new surgery-related aphasia by the presence of detectable IC. RESULTS Language mapping by nTMS was possible in all patients. Seventeen patients (44.7%) suffered from surgery-related worsening of language performance (transient aphasia according to 3-month follow-up in 16 subjects [42.1%]; new permanent aphasia according to 3-month follow-up in 1 patient [2.6%]). Regarding the correlation of aphasia to nTMS-based IC, statistically significant differences were revealed for both evaluated FA values. However, better results were observed for tractography with an FA of 0.2, which led to a specificity of 93% (postoperative aphasia) and 90% (surgery-related aphasia). For postoperative aphasia, the corresponding OR was 0.1282 (95% CI 0.0143-1.1520), and for surgery-related aphasia the OR was 0.1184 (95% CI 0.0208-0.6754). CONCLUSIONS According to these results, IC detected by preoperative nTMS-based DTI-FT might be regarded as a risk factor for surgery-related aphasia, with a specificity of up to 93%. However, because the majority of enrolled patients suffered from transient aphasia postoperatively, it has to be evaluated whether this approach distinctly leads to similar results among patients with permanent language deficits. Despite this restriction, this approach might contribute to individualized patient consultation prior to tumor resection in clinical practice.
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Affiliation(s)
- Nico Sollmann
- Department of Neurosurgery.,TUM-Neuroimaging Center, and
| | - Chiara Negwer
- Department of Neurosurgery.,TUM-Neuroimaging Center, and
| | - Lorena Tussis
- Department of Neurosurgery.,TUM-Neuroimaging Center, and
| | - Theresa Hauck
- Department of Neurosurgery.,TUM-Neuroimaging Center, and
| | - Sebastian Ille
- Department of Neurosurgery.,TUM-Neuroimaging Center, and
| | | | | | - Jan S Bauer
- Section of Neuroradiology, Department of Radiology, Klinikum rechts der Isar, Technische Universität München, Germany
| | | | | | - Sandro M Krieg
- Department of Neurosurgery.,TUM-Neuroimaging Center, and
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Sollmann N, Ille S, Tussis L, Maurer S, Hauck T, Negwer C, Bauer JS, Ringel F, Meyer B, Krieg SM. Correlating subcortical interhemispheric connectivity and cortical hemispheric dominance in brain tumor patients: A repetitive navigated transcranial magnetic stimulation study. Clin Neurol Neurosurg 2016; 141:56-64. [DOI: 10.1016/j.clineuro.2015.12.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Accepted: 12/14/2015] [Indexed: 12/31/2022]
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32
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Babajani-Feremi A, Narayana S, Rezaie R, Choudhri AF, Fulton SP, Boop FA, Wheless JW, Papanicolaou AC. Language mapping using high gamma electrocorticography, fMRI, and TMS versus electrocortical stimulation. Clin Neurophysiol 2015; 127:1822-36. [PMID: 26679420 DOI: 10.1016/j.clinph.2015.11.017] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Revised: 10/30/2015] [Accepted: 11/19/2015] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The aim of the present study was to compare localization of the language cortex using cortical stimulation mapping (CSM), high gamma electrocorticography (hgECoG), functional magnetic resonance imaging (fMRI), and transcranial magnetic stimulation (TMS). METHODS Language mapping using CSM, hgECoG, fMRI, and TMS were compared in nine patients with epilepsy. Considering CSM as reference, we compared language mapping approaches based on hgECoG, fMRI, and TMS using their sensitivity, specificity, and the results of receiver operating characteristic (ROC) analyses. RESULTS Our results show that areas involved in language processing can be identified by hgECoG, fMRI, and TMS. The average sensitivity/specificity of hgECoG, fMRI, and TMS across all patients was 100%/85%, 50%/80%, and 67%/66%, respectively. The average area under the ROC curve of hgECoG, fMRI, and TMS across CSM-positive patients was 0.98, 0.76, and 0.68, respectively. CONCLUSIONS There is considerable concordance between CSM, hgECoG, fMRI, and TMS language mapping. Our results reveal that hgECoG, fMRI, and TMS are valuable tools for presurgical language mapping. SIGNIFICANCE Language mapping on the basis of hgECoG, fMRI, and TMS can provide important additional information, therefore, these methods can be used in conjunction with CSM or as an alternative, when the latter is deemed impractical.
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Affiliation(s)
- Abbas Babajani-Feremi
- Department of Pediatrics, Division of Clinical Neurosciences, University of Tennessee Health Science Center, Memphis, TN, USA; Neuroscience Institute, Le Bonheur Children's Hospital, Memphis, TN, USA; Department of Anatomy and Neurobiology, University of Tennessee Health Science Center, Memphis, TN, USA.
| | - Shalini Narayana
- Department of Pediatrics, Division of Clinical Neurosciences, University of Tennessee Health Science Center, Memphis, TN, USA; Neuroscience Institute, Le Bonheur Children's Hospital, Memphis, TN, USA; Department of Anatomy and Neurobiology, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Roozbeh Rezaie
- Department of Pediatrics, Division of Clinical Neurosciences, University of Tennessee Health Science Center, Memphis, TN, USA; Neuroscience Institute, Le Bonheur Children's Hospital, Memphis, TN, USA
| | - Asim F Choudhri
- Neuroscience Institute, Le Bonheur Children's Hospital, Memphis, TN, USA; Department of Radiology, University of Tennessee Health Science Center, Memphis, TN, USA; Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Stephen P Fulton
- Neuroscience Institute, Le Bonheur Children's Hospital, Memphis, TN, USA; Department of Pediatrics, Division of Pediatric Neurology, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Frederick A Boop
- Neuroscience Institute, Le Bonheur Children's Hospital, Memphis, TN, USA; Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, TN, USA
| | - James W Wheless
- Neuroscience Institute, Le Bonheur Children's Hospital, Memphis, TN, USA; Department of Pediatrics, Division of Pediatric Neurology, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Andrew C Papanicolaou
- Department of Pediatrics, Division of Clinical Neurosciences, University of Tennessee Health Science Center, Memphis, TN, USA; Neuroscience Institute, Le Bonheur Children's Hospital, Memphis, TN, USA; Department of Anatomy and Neurobiology, University of Tennessee Health Science Center, Memphis, TN, USA
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Non-invasive mapping of calculation function by repetitive navigated transcranial magnetic stimulation. Brain Struct Funct 2015; 221:3927-3947. [PMID: 26507738 DOI: 10.1007/s00429-015-1136-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2015] [Accepted: 10/16/2015] [Indexed: 12/29/2022]
Abstract
Concerning calculation function, studies have already reported on localizing computational function in patients and volunteers by functional magnetic resonance imaging and transcranial magnetic stimulation. However, the development of accurate repetitive navigated TMS (rTMS) with a considerably higher spatial resolution opens a new field in cognitive neuroscience. This study was therefore designed to evaluate the feasibility of rTMS for locating cortical calculation function in healthy volunteers, and to establish this technique for future scientific applications as well as preoperative mapping in brain tumor patients. Twenty healthy subjects underwent rTMS calculation mapping using 5 Hz/10 pulses. Fifty-two previously determined cortical spots of the whole hemispheres were stimulated on both sides. The subjects were instructed to perform the calculation task composed of 80 simple arithmetic operations while rTMS pulses were applied. The highest error rate (80 %) for all errors of all subjects was observed in the right ventral precentral gyrus. Concerning division task, a 45 % error rate was achieved in the left middle frontal gyrus. The subtraction task showed its highest error rate (40 %) in the right angular gyrus (anG). In the addition task a 35 % error rate was observed in the left anterior superior temporal gyrus. Lastly, the multiplication task induced a maximum error rate of 30 % in the left anG. rTMS seems feasible as a way to locate cortical calculation function. Besides language function, the cortical localizations are well in accordance with the current literature for other modalities or lesion studies.
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Vitikainen AM, Mäkelä E, Lioumis P, Jousmäki V, Mäkelä JP. Accelerometer-based automatic voice onset detection in speech mapping with navigated repetitive transcranial magnetic stimulation. J Neurosci Methods 2015; 253:70-7. [DOI: 10.1016/j.jneumeth.2015.05.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Revised: 05/19/2015] [Accepted: 05/21/2015] [Indexed: 10/23/2022]
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35
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Ille S, Sollmann N, Hauck T, Maurer S, Tanigawa N, Obermueller T, Negwer C, Droese D, Boeckh-Behrens T, Meyer B, Ringel F, Krieg SM. Impairment of preoperative language mapping by lesion location: a functional magnetic resonance imaging, navigated transcranial magnetic stimulation, and direct cortical stimulation study. J Neurosurg 2015; 123:314-24. [DOI: 10.3171/2014.10.jns141582] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECT
Language mapping by repetitive navigated transcranial magnetic stimulation (rTMS) is increasingly used and has already replaced functional MRI (fMRI) in some institutions for preoperative mapping of neurosurgical patients. Yet some factors affect the concordance of both methods with direct cortical stimulation (DCS), most likely by lesions affecting cortical oxygenation levels. Therefore, the impairment of the accuracy of rTMS and fMRI was analyzed and compared with DCS during awake surgery in patients with intraparenchymal lesions.
METHODS
Language mapping was performed by DCS, rTMS, and fMRI using an object-naming task in 27 patients with left-sided perisylvian lesions, and the induced language errors of each method were assigned to the cortical parcellation system. Subsequently, the receiver operating characteristics were calculated for rTMS and fMRI and compared with DCS as ground truth for regions with (w/) and without (w/o) the lesion in the mapped regions.
RESULTS
The w/ subgroup revealed a sensitivity of 100% (w/o 100%), a specificity of 8% (w/o 5%), a positive predictive value of 34% (w/o: 53%), and a negative predictive value (NPV) of 100% (w/o: 100%) for the comparison of rTMS versus DCS. Findings for the comparison of fMRI versus DCS within the w/ subgroup revealed a sensitivity of 32% (w/o: 62%), a specificity of 88% (w/o: 60%), a positive predictive value of 56% (w/o: 62%), and a NPV of 73% (w/o: 60%).
CONCLUSIONS
Although strengths and weaknesses exist for both rTMS and fMRI, the results show that rTMS is less affected by a brain lesion than fMRI, especially when performing mapping of language-negative cortical regions based on sensitivity and NPV.
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Affiliation(s)
| | - Nico Sollmann
- 1Department of Neurosurgery,
- 2TUM-Neuroimaging Center,
| | - Theresa Hauck
- 1Department of Neurosurgery,
- 2TUM-Neuroimaging Center,
| | | | - Noriko Tanigawa
- 5Faculty of Linguistics, Philology, & Phonetics, University of Oxford, Oxford, United Kingdom
| | | | - Chiara Negwer
- 1Department of Neurosurgery,
- 2TUM-Neuroimaging Center,
| | - Doris Droese
- 4Department of Anesthesiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany; and
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Ille S, Sollmann N, Hauck T, Maurer S, Tanigawa N, Obermueller T, Negwer C, Droese D, Zimmer C, Meyer B, Ringel F, Krieg SM. Combined noninvasive language mapping by navigated transcranial magnetic stimulation and functional MRI and its comparison with direct cortical stimulation. J Neurosurg 2015; 123:212-25. [DOI: 10.3171/2014.9.jns14929] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECT
Repetitive navigated transcranial magnetic stimulation (rTMS) is now increasingly used for preoperative language mapping in patients with lesions in language-related areas of the brain. Yet its correlation with intraoperative direct cortical stimulation (DCS) has to be improved. To increase rTMS's specificity and positive predictive value, the authors aim to provide thresholds for rTMS's positive language areas. Moreover, they propose a protocol for combining rTMS with functional MRI (fMRI) to combine the strength of both methods.
METHODS
The authors performed multimodal language mapping in 35 patients with left-sided perisylvian lesions by using rTMS, fMRI, and DCS. The rTMS mappings were conducted with a picture-to-trigger interval (PTI, time between stimulus presentation and stimulation onset) of either 0 or 300 msec. The error rates (ERs; that is, the number of errors per number of stimulations) were calculated for each region of the cortical parcellation system (CPS). Subsequently, the rTMS mappings were analyzed through different error rate thresholds (ERT; that is, the ER at which a CPS region was defined as language positive in terms of rTMS), and the 2-out-of-3 rule (a stimulation site was defined as language positive in terms of rTMS if at least 2 out of 3 stimulations caused an error). As a second step, the authors combined the results of fMRI and rTMS in a predefined protocol of combined noninvasive mapping. To validate this noninvasive protocol, they correlated its results to DCS during awake surgery.
RESULTS
The analysis by different rTMS ERTs obtained the highest correlation regarding sensitivity and a low rate of false positives for the ERTs of 15%, 20%, 25%, and the 2-out-of-3 rule. However, when comparing the combined fMRI and rTMS results with DCS, the authors observed an overall specificity of 83%, a positive predictive value of 51%, a sensitivity of 98%, and a negative predictive value of 95%.
CONCLUSIONS
In comparison with fMRI, rTMS is a more sensitive but less specific tool for preoperative language mapping than DCS. Moreover, rTMS is most reliable when using ERTs of 15%, 20%, 25%, or the 2-out-of-3 rule and a PTI of 0 msec. Furthermore, the combination of fMRI and rTMS leads to a higher correlation to DCS than both techniques alone, and the presented protocols for combined noninvasive language mapping might play a supportive role in the language-mapping assessment prior to the gold-standard intraoperative DCS.
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Affiliation(s)
| | | | | | | | - Noriko Tanigawa
- 5Faculty of Linguistics, Philology, & Phonetics, University of Oxford, United Kingdom
| | | | | | - Doris Droese
- 4Department of Anesthesiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany; and
| | - Claus Zimmer
- 2TUM-Neuroimaging Center
- 3Section of Neuroradiology, Department of Radiology; and
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Könönen M, Tamsi N, Säisänen L, Kemppainen S, Määttä S, Julkunen P, Jutila L, Äikiä M, Kälviäinen R, Niskanen E, Vanninen R, Karjalainen P, Mervaala E. Non-invasive mapping of bilateral motor speech areas using navigated transcranial magnetic stimulation and functional magnetic resonance imaging. J Neurosci Methods 2015; 248:32-40. [DOI: 10.1016/j.jneumeth.2015.03.030] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2014] [Revised: 03/26/2015] [Accepted: 03/27/2015] [Indexed: 10/23/2022]
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Task type affects location of language-positive cortical regions by repetitive navigated transcranial magnetic stimulation mapping. PLoS One 2015; 10:e0125298. [PMID: 25928744 PMCID: PMC4415771 DOI: 10.1371/journal.pone.0125298] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Accepted: 03/12/2015] [Indexed: 11/25/2022] Open
Abstract
Objectives Recent repetitive TMS (rTMS) mapping protocols for language mapping revealed deficits of this method, mainly in posterior brain regions. Therefore this study analyzed the impact of different language tasks on the localization of language-positive brain regions and compared their effectiveness, especially with regard to posterior brain regions. Methods Nineteen healthy, right-handed subjects performed object naming, pseudoword reading, verb generation, and action naming during rTMS language mapping of the left hemisphere. Synchronically, 5 Hz/10 pulses were applied with a 0 ms delay Results The object naming task evoked the highest error rate (14%), followed by verb generation (13%) and action naming (11%). The latter revealed more errors in posterior than in anterior areas. Pseudoword reading barely generated errors, except for phonological paraphasias. Conclusions In general, among the evaluated language tasks, object naming is the most discriminative task to detect language-positive regions via rTMS. However, other tasks might be used for more specific questions.
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Cortical distribution of speech and language errors investigated by visual object naming and navigated transcranial magnetic stimulation. Brain Struct Funct 2015; 221:2259-86. [DOI: 10.1007/s00429-015-1042-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Accepted: 04/03/2015] [Indexed: 01/07/2023]
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40
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Sollmann N, Ille S, Hauck T, Maurer S, Negwer C, Zimmer C, Ringel F, Meyer B, Krieg SM. The impact of preoperative language mapping by repetitive navigated transcranial magnetic stimulation on the clinical course of brain tumor patients. BMC Cancer 2015; 15:261. [PMID: 25885761 PMCID: PMC4404089 DOI: 10.1186/s12885-015-1299-5] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Accepted: 03/31/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Language mapping by repetitive navigated transcranial magnetic stimulation (rTMS) is used for resection planning in patients suffering from brain lesions within regions known to be involved in language function. Yet we also need data that show whether patients benefit clinically from preoperative rTMS for language mapping. METHODS We enrolled 25 patients with language eloquently located brain lesions undergoing preoperative rTMS language mapping (GROUP 1, 2011-2013), with the mapping results not being available for the surgeon, and we matched these patients with 25 subjects who also underwent preoperative rTMS (GROUP 2, 2013-2014), but the mapping results were taken into account during tumor resection. Additionally, cortical language maps were generated by analyzing preoperative rTMS and intraoperative direct cortical stimulation (DCS) data. RESULTS Mean anterior-posterior (ap) craniotomy extents and overall craniotomy sizes were significantly smaller for the patients in GROUP 2 (Ap: p = 0.0117; overall size: p = 0.0373), and postoperative language deficits were found significantly more frequently for the patients in GROUP 1 (p = 0.0153), although the preoperative language status did not differ between groups (p = 0.7576). Additionally, there was a trend towards fewer unexpected tumor residuals, shorter surgery duration, less peri- or postoperative complications, shorter inpatient stay, and higher postoperative Karnofsky performance status scale (KPS) for the patients in GROUP 2. CONCLUSIONS The present study provides a first hint that the clinical course of patients suffering from brain tumors might be improved by preoperative rTMS language mapping. However, a significant difference between both groups was only found for craniotomy extents and postoperative deficits, but not for other clinical parameters, which only showed a trend toward better results in GROUP 2. Therefore, multicenter trials with higher sample sizes are needed to further investigate the distinct impact of rTMS language mapping on the clinical course of brain tumor patients.
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Affiliation(s)
- Nico Sollmann
- Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany. .,TUM-Neuroimaging Center, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany.
| | - Sebastian Ille
- Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany. .,TUM-Neuroimaging Center, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany.
| | - Theresa Hauck
- Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany. .,TUM-Neuroimaging Center, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany.
| | - Stefanie Maurer
- Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany. .,TUM-Neuroimaging Center, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany.
| | - Chiara Negwer
- Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany. .,TUM-Neuroimaging Center, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany.
| | - Claus Zimmer
- TUM-Neuroimaging Center, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany. .,Section of Neuroradiology, Department of Radiology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany.
| | - Florian Ringel
- Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany.
| | - Bernhard Meyer
- Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany.
| | - Sandro M Krieg
- Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany. .,TUM-Neuroimaging Center, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany.
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Krieg SM, Sollmann N, Obermueller T, Sabih J, Bulubas L, Negwer C, Moser T, Droese D, Boeckh-Behrens T, Ringel F, Meyer B. Changing the clinical course of glioma patients by preoperative motor mapping with navigated transcranial magnetic brain stimulation. BMC Cancer 2015; 15:231. [PMID: 25884404 PMCID: PMC4423137 DOI: 10.1186/s12885-015-1258-1] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Accepted: 03/25/2015] [Indexed: 01/21/2023] Open
Abstract
Background Mapping of the motor cortex by navigated transcranial magnetic stimulation (nTMS) can be used for preoperative planning in brain tumor patients. Just recently, it has been proven to actually change outcomes by increasing the rate of gross total resection (GTR) and by reducing the surgery-related rate of paresis significantly in cohorts of patients suffering from different entities of intracranial lesions. Yet, we also need data that shows whether these changes also lead to a changed clinical course, and can also be achieved specifically in high-grade glioma (HGG) patients. Methods We prospectively enrolled 70 patients with supratentorial motor eloquently located HGG undergoing preoperative nTMS (2010–2014) and matched these patients with 70 HGG patients who did not undergo preoperative nTMS (2007–2010). Results On average, the overall size of the craniotomy was significantly smaller for nTMS patients when compared to the non-nTMS group (nTMS: 25.3 ± 9.7 cm2; non-nTMS: 30.8 ± 13.2 cm2; p = 0.0058). Furthermore, residual tumor tissue (nTMS: 34.3%; non-nTMS: 54.3%; p = 0.0172) and unexpected tumor residuals (nTMS: 15.7%; non-nTMS: 32.9%; p = 0.0180) were less frequent in nTMS patients. Regarding the further clinical course, median inpatient stay was 12 days for the nTMS and 14 days for the non-nTMS group (nTMS: CI 10.5 – 13.5 days; non-nTMS: CI 11.6 – 16.4 days; p = 0.0446). 60.0% of patients of the nTMS group and 54.3% of patients of the non-nTMS group were eligible for postoperative chemotherapy (OR 1.2630, CI 0.6458 – 2.4710, p = 0.4945), while 67.1% of nTMS patients and 48.6% of non-nTMS patients received radiotherapy (OR 2.1640, CI 1.0910 – 4.2910, p = 0.0261). Moreover, 3, 6, and 9 months survival was significantly better in the nTMS group (p = 0.0298, p = 0.0015, and p = 0.0167). Conclusions With the limitations of this study in mind, our data show that HGG patients might benefit from preoperative nTMS mapping.
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Affiliation(s)
- Sandro M Krieg
- Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany. .,TUM-Neuroimaging Center, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany.
| | - Nico Sollmann
- Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany. .,TUM-Neuroimaging Center, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany. .,Section of Neuroradiology, Department of Radiology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany.
| | - Thomas Obermueller
- Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany. .,TUM-Neuroimaging Center, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany.
| | - Jamil Sabih
- Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany. .,TUM-Neuroimaging Center, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany.
| | - Lucia Bulubas
- Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany. .,TUM-Neuroimaging Center, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany.
| | - Chiara Negwer
- Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany.
| | - Tobias Moser
- Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany. .,TUM-Neuroimaging Center, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany.
| | - Doris Droese
- Department of Anesthesiology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, München, 81675, Germany.
| | - Tobias Boeckh-Behrens
- Section of Neuroradiology, Department of Radiology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany.
| | - Florian Ringel
- Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany.
| | - Bernhard Meyer
- Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany.
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Sollmann N, Ille S, Obermueller T, Negwer C, Ringel F, Meyer B, Krieg SM. The impact of repetitive navigated transcranial magnetic stimulation coil positioning and stimulation parameters on human language function. Eur J Med Res 2015; 20:47. [PMID: 25889025 PMCID: PMC4382854 DOI: 10.1186/s40001-015-0138-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Accepted: 03/19/2015] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Repetitive navigated transcranial magnetic stimulation (rTMS) in combination with object naming is able to elicit naming errors by stimulating language-related brain regions. However, stimulation results mainly depend on coil positioning and stimulation parameters, which have not been investigated since the implementation of neuronavigation to transcranial magnetic stimulation. Therefore, the following three parameters were systematically examined in the present study: coil angulation, stimulation frequency, and stimulation intensity. METHODS Five healthy, right-handed subjects underwent rTMS language mapping of Broca's as well as Wernicke's areas of the left hemisphere. During mapping sessions, coil angulation was changed clockwise in 45° steps, and the stimulation frequency and intensity were varied within a considerably wide range. For angulation, the anterior-posterior (ap) coil orientation was used as reference position. RESULTS An angulation of 90° to ap coil orientation led to the highest rate of naming errors within Broca's area, whereas an inhomogeneous distribution of angulations was observed during stimulation of Wernicke's area. Therefore, ap coil orientation, which is regarded as standard in rTMS language mapping, could not be approved as the optimal position. With regard to stimulation parameters, 20 Hz and 120% of the resting motor threshold (RMT) were defined as optimal. CONCLUSIONS Coil angulation, stimulation frequency, and stimulation intensity have significant impacts on language impairment during rTMS mapping. The variation of only one of these parameters already leads to a clearer disruption of language performance. Therefore, individually adapted stimulation protocols have to be determined prior to language mapping in order to improve mapping results.
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Affiliation(s)
- Nico Sollmann
- Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany. .,TUM-Neuroimaging Center, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany.
| | - Sebastian Ille
- Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany. .,TUM-Neuroimaging Center, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany.
| | - Thomas Obermueller
- Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany. .,TUM-Neuroimaging Center, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany.
| | - Chiara Negwer
- Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany. .,TUM-Neuroimaging Center, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany.
| | - Florian Ringel
- Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany. .,TUM-Neuroimaging Center, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany.
| | - Bernhard Meyer
- Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany.
| | - Sandro M Krieg
- Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany. .,TUM-Neuroimaging Center, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany.
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43
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Sollmann N, Tanigawa N, Tussis L, Hauck T, Ille S, Maurer S, Negwer C, Zimmer C, Ringel F, Meyer B, Krieg SM. Cortical regions involved in semantic processing investigated by repetitive navigated transcranial magnetic stimulation and object naming. Neuropsychologia 2015; 70:185-95. [DOI: 10.1016/j.neuropsychologia.2015.02.035] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Revised: 02/23/2015] [Accepted: 02/24/2015] [Indexed: 11/28/2022]
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Hauck T, Tanigawa N, Probst M, Wohlschlaeger A, Ille S, Sollmann N, Maurer S, Zimmer C, Ringel F, Meyer B, Krieg SM. Stimulation frequency determines the distribution of language positive cortical regions during navigated transcranial magnetic brain stimulation. BMC Neurosci 2015; 16:5. [PMID: 25880838 PMCID: PMC4339007 DOI: 10.1186/s12868-015-0143-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Accepted: 02/11/2015] [Indexed: 11/28/2022] Open
Abstract
Background Although language mapping by repetitive navigated transcranial magnetic stimulation (rTMS) gains importance in neuropsychological research and clinical utility, neuroscientists still use different mapping protocols including different stimulation frequencies. To refine the existing language protocol, we tested two different repetition rates of 5 Hz/10 pulses and 7 Hz/10 pulses with a 0 ms delay in 19 healthy subjects. We furthermore investigated differences between both frequencies in case of performance of four different language tasks: object naming, pseudoword reading, verb generation, and action naming. Results Even the small variance in frequencies revealed statistically significant differences concerning the number and type of language errors. Stimulation with 5 Hz evoked a higher number of all occurred language errors in all language tasks (error rate object naming 14% (5 Hz) vs. 12% (7 Hz); pseudoword reading 4% (5 Hz) vs. 3% (7 Hz); verb generation 13% (5 Hz) vs. 11% (7 Hz); action naming 11% (5 Hz) vs. 9% (7 Hz)), whereas 7 Hz evoked specifically more total speech arrests. Conclusion These findings suggest that the stimulation frequency has to be adapted to the aim of the rTMS language investigation.
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Affiliation(s)
- Theresa Hauck
- Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany.
| | - Noriko Tanigawa
- Faculty of Linguistics, Philology, & Phonetics, University of Oxford, Walton Street, Oxford, OX1 2HG, UK.
| | - Monika Probst
- Section of Neuroradiology, Department of Radiology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany.
| | - Afra Wohlschlaeger
- Section of Neuroradiology, Department of Radiology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany.
| | - Sebastian Ille
- Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany.
| | - Nico Sollmann
- Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany.
| | - Stefanie Maurer
- Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany.
| | - Claus Zimmer
- Section of Neuroradiology, Department of Radiology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany.
| | - Florian Ringel
- Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany.
| | - Bernhard Meyer
- Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany.
| | - Sandro M Krieg
- Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany.
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Language and its right-hemispheric distribution in healthy brains: An investigation by repetitive transcranial magnetic stimulation. Neuroimage 2014; 102 Pt 2:776-88. [PMID: 25219508 DOI: 10.1016/j.neuroimage.2014.09.002] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Revised: 07/15/2014] [Accepted: 09/02/2014] [Indexed: 01/10/2023] Open
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Optimal timing of pulse onset for language mapping with navigated repetitive transcranial magnetic stimulation. Neuroimage 2014; 100:219-36. [DOI: 10.1016/j.neuroimage.2014.06.016] [Citation(s) in RCA: 82] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Revised: 04/21/2014] [Accepted: 06/06/2014] [Indexed: 11/22/2022] Open
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Hernandez-Pavon JC, Mäkelä N, Lehtinen H, Lioumis P, Mäkelä JP. Effects of navigated TMS on object and action naming. Front Hum Neurosci 2014; 8:660. [PMID: 25228868 PMCID: PMC4151040 DOI: 10.3389/fnhum.2014.00660] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Accepted: 08/08/2014] [Indexed: 01/22/2023] Open
Abstract
Transcranial magnetic stimulation (TMS) has been used to induce speech disturbances and to affect speech performance during different naming tasks. Lately, repetitive navigated TMS (nTMS) has been used for non-invasive mapping of cortical speech-related areas. Different naming tasks may give different information that can be useful for presurgical evaluation. We studied the sensitivity of object and action naming tasks to nTMS and compared the distributions of cortical sites where nTMS produced naming errors. Eight healthy subjects named pictures of objects and actions during repetitive nTMS delivered to semi-random left-hemispheric sites. Subject-validated image stacks were obtained in the baseline naming of all pictures before nTMS. Thereafter, nTMS pulse trains were delivered while the subjects were naming the images of objects or actions. The sessions were video-recorded for offline analysis. Naming during nTMS was compared with the baseline performance. The nTMS-induced naming errors were categorized by error type and location. nTMS produced no-response errors, phonological paraphasias, and semantic paraphasias. In seven out of eight subjects, nTMS produced more errors during object than action naming. Both intrasubject and intersubject analysis showed that object naming was significantly more sensitive to nTMS. When the number of errors was compared according to a given area, nTMS to postcentral gyrus induced more errors during object than action naming. Object naming is apparently more easily disrupted by TMS than action naming. Different stimulus types can be useful for locating different aspects of speech functions. This provides new possibilities in both basic and clinical research of cortical speech representations.
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Affiliation(s)
- Julio C Hernandez-Pavon
- Department of Biomedical Engineering and Computational Science, Aalto University School of Science Espoo, Finland ; BioMag Laboratory, HUS Medical Imaging Center, Helsinki University Central Hospital Helsinki, Finland
| | - Niko Mäkelä
- Department of Biomedical Engineering and Computational Science, Aalto University School of Science Espoo, Finland ; BioMag Laboratory, HUS Medical Imaging Center, Helsinki University Central Hospital Helsinki, Finland
| | - Henri Lehtinen
- Epilepsy Unit, Department of Pediatric Neurology, Helsinki University Central Hospital Helsinki, Finland
| | - Pantelis Lioumis
- BioMag Laboratory, HUS Medical Imaging Center, Helsinki University Central Hospital Helsinki, Finland
| | - Jyrki P Mäkelä
- BioMag Laboratory, HUS Medical Imaging Center, Helsinki University Central Hospital Helsinki, Finland
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Methods for estimating cortical motor representation size and location in navigated transcranial magnetic stimulation. J Neurosci Methods 2014; 232:125-33. [DOI: 10.1016/j.jneumeth.2014.05.020] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Revised: 05/14/2014] [Accepted: 05/15/2014] [Indexed: 11/20/2022]
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Picht T, Schilt S, Frey D, Vajkoczy P, Kufeld M. Integration of navigated brain stimulation data into radiosurgical planning: potential benefits and dangers. Acta Neurochir (Wien) 2014; 156:1125-33. [PMID: 24744010 DOI: 10.1007/s00701-014-2079-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Accepted: 03/25/2014] [Indexed: 02/03/2023]
Abstract
BACKGROUND Radiosurgical treatment of brain lesions near motor or language eloquent areas requires careful planning to achieve the optimal balance between effective dose prescription and preservation of function. Navigated brain stimulation (NBS) is the only non-invasive modality that allows the identification of functionally essential areas by electrical stimulation or inhibition of cortical neurons analogous to the gold-standard of intraoperative electrical mapping. OBJECTIVE To evaluate the feasibility of NBS data integration into the radiosurgical environment, and to analyze the influence of NBS data on the radiosurgical treatment planning for lesions near or within motor or language eloquent areas of the brain. METHODS Eleven consecutive patients with brain lesions in presumed motor or language eloquent locations eligible for radiosurgical treatment were mapped with NBS. The radiosurgical team prospectively analyzed the data transfer and classified the influence of the functional NBS information on the radiosurgical treatment planning using a standardized questionnaire. RESULTS The semi-automatized data transfer to the radiosurgical planning workstation was flawless in all cases. The NBS data influenced the radiosurgical treatment planning procedure as follows: improved risk-benefit balancing in all cases, target contouring in 0 %, dose plan modification in 81.9 %, reduction of radiation dosage in 72.7 % and treatment indication in 63.7 % of the cases. CONCLUSIONS NBS data integration into radiosurgical treatment planning is feasible. By mapping the spatial relationship between the lesion and functionally essential areas, NBS has the potential to improve radiosurgical planning safety for eloquently located lesions.
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Affiliation(s)
- Thomas Picht
- Department of Neurosurgery, Charité University Hospital, Augustenburger Platz 1, 13353, Berlin, Germany,
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Functional brain mapping of patients with arteriovenous malformations using navigated transcranial magnetic stimulation: first experience in ten patients. Acta Neurochir (Wien) 2014; 156:885-95. [PMID: 24639144 DOI: 10.1007/s00701-014-2043-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2013] [Accepted: 02/16/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Intracranial arteriovenous malformations (AVM) are known to be potent inductors of functional plasticity, and their vasculature makes standard functional imaging difficult. Here we conducted functional mapping of both primary motor cortex and speech related areas in patients with AVM using navigated transcranial magnetic stimulation (nTMS), which has been recently proven as a reliable noninvasive modality of preoperative functional brain mapping. METHOD nTMS mapping was performed in ten patients with unruptured intracranial AVMs located in or near eloquent areas. Motor mapping was conducted for six patients with AVMs near the rolandic region, and speech mapping was performed for four patients with left perisylvian AVMs. After the examination, all patients were treated with surgery, radiosurgery or observed with best medical treatment on case-by-case basis. RESULTS Motor mapping allowed for delineation of the primary motor cortex, even if the anatomy was severely obscured by the AVM in all cases with rolandic AVMs. No plastic relocation of the primary motor cortex was observed. Repetitive stimulation of the left ventral precentral gyrus led to speech impairments in all four cases that underwent speech mapping. Right hemispheric involvement was observed in one out of four cases and potentially indicated plastic changes. No side effects were observed. CONCLUSION nTMS allowed for detailed delineation of eloquent areas even within hypervascularized cortical areas. Our observations indicate that nTMS functional mapping is feasible not only in tumorous brain lesions, but also in AVMs.
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