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. Issue 4 (29th November 2017)

• Record Type: Journal Article
• Authors: Raffa, Giovanni; Conti, Alfredo; Scibilia, Antonino; Cardali, Salvatore Massimiliano; Esposito, Felice; Angileri, Filippo Flavio; La Torre, Domenico; Sindorio, Carmela; Abbritti, Rosaria Viola; Germanò, Antonino; Tomasello, Francesco
• Is Part Of: Neurosurgery. Volume 83:Issue 4(2018)
• Page Start: 768
• Page End: 782
• Publication Date: 2017-11-29
• Subjects: Brain tumors -- Corticospinal tract -- DTI tractography -- Eloquent areas -- Motor cortex -- Navigated transcranial magnetic stimulation; Nervous system -- Surgery -- Periodicals; 617.48005
• DOI: 10.1093/neuros/nyx554
• Languages: English
• ISSNs: 0148-396X

Abstract

Abstract: BACKGROUND: Navigated transcranial magnetic stimulation (nTMS) enables preoperative mapping of the motor cortex (M1). The combination of nTMS with 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 of motor-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 postoperative motor 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 motor-eloquent lesions. It may improve the risk/benefit analysis, EOR and outcome, particularly when nTMS-based DTI-FT is performed.