Please use this identifier to cite or link to this item: doi:10.22028/D291-39794
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Title: Preoperative Navigated Transcranial Magnetic Stimulation Improves Gross Total Resection Rates in Patients with Motor-Eloquent High-Grade Gliomas: A Matched Cohort Study
Author(s): Hendrix, Philipp
Dzierma, Yvonne
Burkhardt, Benedikt W
Simgen, Andreas
Wagenpfeil, Gudrun
Griessenauer, Christoph J
Senger, Sebastian
Oertel, Joachim
Language: English
Title: Neurosurgery
Volume: 88
Issue: 3
Pages: 627-636
Publisher/Platform: Wolters Kluwer
Year of Publication: 2021
Free key words: Brain tumors
Eloquent areas
Motor cortex
Navigated transcranial magnetic stimulation
DDC notations: 610 Medicine and health
Publikation type: Journal Article
Abstract: BACKGROUND Navigated transcranial magnetic stimulation (nTMS) is an established, noninvasive tool to preoperatively map the motor cortex. Despite encouraging reports from few academic centers with vast nTMS experience, its value for motor-eloquent brain surgery still requires further exploration. OBJECTIVE To further elucidate the role of preoperative nTMS in motor-eloquent brain surgery. METHODS Patients who underwent surgery for a motor-eloquent supratentorial glioma or metastasis guided by preoperative nTMS were retrospectively reviewed. The nTMS group (n = 105) was pair-matched to controls (non-nTMS group, n = 105). Gross total resection (GTR) and motor outcome were evaluated. Subgroup analyses including survival analysis for WHO III/IV glioma were performed. RESULTS GTR was significantly more frequently achieved in the entire nTMS group compared to the non-nTMS group (P = .02). Motor outcome did not differ (P = .344). Bootstrap analysis confirmed these findings. In the metastases subgroup, GTR rates and motor outcomes were equal. In the WHO III/IV glioma subgroup, however, GTR was achieved more frequently in the nTMS group (72.3%) compared to non-nTMS group (53.2%) (P = .049), whereas motor outcomes did not differ (P = .521). In multivariable Cox-regression analysis, prolonged survival in WHO III/IV glioma was significantly associated with achievement of GTR and younger patient age but not nTMS mapping. CONCLUSION Preoperative nTMS improves GTR rates without jeopardizing neurological function. In WHO III/IV glioma surgery, nTMS increases GTR rates that might translate into a beneficial overall survival. The value of nTMS in the setting of a potential survival benefit remains to be determined.
DOI of the first publication: 10.1093/neuros/nyaa486
Link to this record: urn:nbn:de:bsz:291--ds-397942
ISSN: 1524-4040
Date of registration: 17-May-2023
Faculty: M - Medizinische Fakultät
Department: M - Neurochirurgie
Professorship: M - Prof. Dr. Joachim Oertel
Collections:SciDok - Der Wissenschaftsserver der Universität des Saarlandes

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