Artikel
Preoperative navigated transcranial magnetic brain stimulation for tumors of the motor cortex
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Veröffentlicht: | 4. Juni 2012 |
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Gliederung
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Objective: Navigated brain stimulation is a newly evolving technique independent from the it's accuracy compared to more commonly used modalities like direct cortical stimulation (DCS) and functional MRI (fMRI).
Methods: We examined 50 patients with tumors in or close to the precentral gyrus as well as in the subcortical white matter motor tract using navigated brain stimulation (NBS) with the Nexstim eXimia system. Data were sent to the neuronavigation system and correlated with intraoperative direct cortical stimulation.
Results: For lesions of the precentral gyrus, preoperative motor cortex mapping correlated well with intraoperative DCS with a deviation of 4.4 ± 3.4 mm. Comparing NBS with fMRI however; deviation was quite larger with 9.6 ± 7.9 mm for upper and 14.7 ± 12.4 mm for lower extremities. In patients with subcortical lesions DTI fiber tracking was performed using NBS mapping as seed region, which resulted in a subjectively more specific presentation of the corticospinal tract and less interobserver variability compared to conventional fiber tracking.
Conclusions: NBS correlates well with DCS as gold standard and, therefore, serves as a very valuable tool for non-invasive presurgical mapping of cortical motor presentation which can serve as seed region for DTI fiber tracking.