BACKGROUND:Navigated transcranialmagnetic stimulation (nTMS) enables preoperative mapping of the motor cortex (M1). The combination of nTMSwith diffusion tensor imaging fiber tracking (DTI-FT) of the corticospinal tract (CST) has been described; however, its impact on surgery of motor-eloquent lesions has not been addressed. OBJECTIVE: To analyze the impact of nTMS-based mapping on surgery ofmotor-eloquent lesions. METHODS: In this retrospective case-control study, we reviewed the data of patients operated for suspected motor-eloquent lesions between 2012 and 2015. The patients underwent nTMS mapping of M1 and, from 2014, nTMS-based DTI-FT of the CST. The impact on the preoperative risk/benefit analysis, surgical strategy, craniotomy size, extent of resection (EOR), and outcome were compared with a control group. RESULTS: We included 35 patients who underwent nTMS mapping of M1 (group A), 35 patients who also underwent nTMS-based DTI-FT of the CST (group B), and a control group composed of 35 patients treated without nTMS (group C). The patients in groups A and B received smaller craniotomies (P = .01; P = .001), had less postoperative seizures (P = .02), and a better postoperativemotor performance (P=.04) and Karnofsky Performance Status (P=.009) than the controls. Group B exhibited an improved risk/benefit analysis (P=.006), an increased EOR of nTMS-negative lesions in absence of preoperative motor deficits (P = .01), and less motor and Karnofsky Performance Status worsening in case of preoperative motor deficits (P = .02, P = .03) than group A. CONCLUSION: nTMS-based mapping enables a tailored surgical approach for motoreloquent lesions. It may improve the risk/benefit analysis, EOR and outcome, particularly when nTMS-based DTI-FT is performed.

The Impact of Diffusion Tensor Imaging Fiber Tracking of the Corticospinal Tract Based on Navigated Transcranial Magnetic Stimulation on Surgery of Motor-Eloquent Brain Lesions

Raffa, Giovanni
Primo
Conceptualization
;
Conti, Alfredo
Supervision
;
Scibilia, Antonino
Writing – Original Draft Preparation
;
Cardali, Salvatore Massimiliano
Membro del Collaboration Group
;
Esposito, Felice
Membro del Collaboration Group
;
Angileri, Filippo Flavio
Membro del Collaboration Group
;
La Torre, Domenico
Membro del Collaboration Group
;
Sindorio, Carmela
Membro del Collaboration Group
;
Abbritti, Rosaria Viola
Membro del Collaboration Group
;
Germanò, Antonino
Supervision
;
Tomasello, Francesco
Ultimo
Supervision
2018-01-01

Abstract

BACKGROUND:Navigated transcranialmagnetic stimulation (nTMS) enables preoperative mapping of the motor cortex (M1). The combination of nTMSwith diffusion tensor imaging fiber tracking (DTI-FT) of the corticospinal tract (CST) has been described; however, its impact on surgery of motor-eloquent lesions has not been addressed. OBJECTIVE: To analyze the impact of nTMS-based mapping on surgery ofmotor-eloquent lesions. METHODS: In this retrospective case-control study, we reviewed the data of patients operated for suspected motor-eloquent lesions between 2012 and 2015. The patients underwent nTMS mapping of M1 and, from 2014, nTMS-based DTI-FT of the CST. The impact on the preoperative risk/benefit analysis, surgical strategy, craniotomy size, extent of resection (EOR), and outcome were compared with a control group. RESULTS: We included 35 patients who underwent nTMS mapping of M1 (group A), 35 patients who also underwent nTMS-based DTI-FT of the CST (group B), and a control group composed of 35 patients treated without nTMS (group C). The patients in groups A and B received smaller craniotomies (P = .01; P = .001), had less postoperative seizures (P = .02), and a better postoperativemotor performance (P=.04) and Karnofsky Performance Status (P=.009) than the controls. Group B exhibited an improved risk/benefit analysis (P=.006), an increased EOR of nTMS-negative lesions in absence of preoperative motor deficits (P = .01), and less motor and Karnofsky Performance Status worsening in case of preoperative motor deficits (P = .02, P = .03) than group A. CONCLUSION: nTMS-based mapping enables a tailored surgical approach for motoreloquent lesions. It may improve the risk/benefit analysis, EOR and outcome, particularly when nTMS-based DTI-FT is performed.
2018
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11570/3120272
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