Postoperative navigated transcranial magnetic stimulation to predict motor recovery after surgery of tumors in motor eloquent areas. Issue 6 (June 2019)

• Record Type: Journal Article
• Authors: Seidel, Kathleen; Häni, Levin; Lutz, Katharina; Zbinden, Chantal; Redmann, Annetta; Consuegra, Alberto; Raabe, Andreas; Schucht, Philippe
• Is Part Of: Clinical neurophysiology. Volume 130:Issue 6(2019:Jun.)
• Page Start: 952
• Page End: 959
• Publication Date: 2019-06
• Subjects: Brain tumor surgery -- Intraoperative neurophysiological monitoring -- Brain mapping -- Motor evoked potential -- Transcranial magnetic stimulation; CST corticospinal tract -- Cing Cingulum -- CUSA Cavitron Ultrasonic Surgical Aspirator -- DCS MEP direct cortical stimulation elicited MEP -- DPM dorsal premotor area -- IOM intraoperative neurophysiological monitoring -- M1 primary motor area -- MRCS Medical Research Council Scale -- MEP motor evoked potential -- MT motor threshold -- nTMS navigated transcranial magnetic stimulation -- RMT resting motor threshold -- SMA supplementary motor area -- TES MEP transcranial electrical stimulation elicited MEP -- VPM ventral premotor area; Neurophysiology -- Periodicals; Electroencephalography -- Periodicals; Electromyography -- Periodicals; Neurology -- Periodicals; 612.8
• DOI: 10.1016/j.clinph.2019.03.015
• Languages: English
• ISSNs: 1388-2457

Abstract

Highlights: We discuss the predictability of reversibility of motor deficits after supratentorial tumor surgery. We describe early postoperative MRI navigated TMS as reliable tool to predict motor recovery. Postoperative nTMS may clarify the potential for recovery in case of intraoperative MEP alterations. Abstract: Objective: To know whether motor deficits after tumor surgery are transient is reassuring for the patient and crucial for planning rehabilitation and adjuvant treatment. We analyze the value of postoperative MRI navigated transcranial magnetic stimulation (nTMS) compared to intraoperative MEP monitoring in predicting recovery of motor function. Methods: Retrospective series of nTMS mappings within 14 days after surgery for supratentorial tumors (09/2014–05/2018). All patients with motor deficits of Medical-Research-Council-Grade (MRCS) 0–4- were included. Results: We performed nTMS mapping on average 3.8 days after surgery and recorded nTMS MEP in 11 of 13 patients. Motor strength recovered to at least MRCS 4 within one month if postoperative nTMS elicited MEPs (positive predictive value 90.9%). If nTMS did not elicit MEPs, the patient did not recover (negative predictive value 100%). Intraoperative MEP and postoperative nTMS were equally predictive for long-term motor recovery. In cases of intraoperative MEP alteration/signal loss, but a positive postoperative nTMS mapping, 2/3 patients demonstrated a good motor recovery. Conclusion: nTMS may predict long-term motor recovery of patients suffering from severe motor deficits directly after resection of tumors located in motor eloquent areas. Significance: In cases of intraoperative MEP alterations, postoperative nTMS may clarify the potential for motor recovery.