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65th Annual Meeting of the German Society of Neurosurgery (DGNC)

German Society of Neurosurgery (DGNC)

11 - 14 May 2014, Dresden

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Preoperative motor mapping by navigated transcranial magnetic brain stimulation improves surgical outcome for motor eloquent lesions

Meeting Abstract

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  • Jamil Sabih - Neurochirurgische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, München, Deutschland
  • Lucia Bulubasova - Neurochirurgische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, München, Deutschland
  • Thomas Obermüller - Neurochirurgische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, München, Deutschland
  • Bernhard Meyer - Neurochirurgische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, München, Deutschland
  • Florian Ringel - Neurochirurgische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, München, Deutschland
  • Sandro M. Krieg - Neurochirurgische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, München, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 65. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC). Dresden, 11.-14.05.2014. Düsseldorf: German Medical Science GMS Publishing House; 2014. DocMI.19.02

doi: 10.3205/14dgnc388, urn:nbn:de:0183-14dgnc3886

Published: May 13, 2014

© 2014 Sabih et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

Outline

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Objective: Navigated transcranial magnetic stimulation (nTMS) has been proven to influence surgical indication and planning. Yet there is still no clear evidence how these additional preoperative functional data influence the clinical course and outcome. Thus, this study aimed to compare patients with motor eloquently located supratentorial lesions investigated with or without preoperative nTMS in terms of clinical outcome parameters.

Method: A prospectively enrolled cohort of 100 patients with supratentorial lesions located in motor eloquent areas was investigated by preoperative nTMS (2010-2013) and matched with a control of 100 patients who were operated on without nTMS data (2006-2010) by a matched pair analysis.

Results: Patients in the nTMS group showed a significantly lower rate of residual tumor on postoperative MRI (OR 0.3828; 95% CI 0.2062 – 0.7107). Twelve percent of patients in the nTMS and 1% of patients in the non-nTMS group improved while 75% and 81% of the nTMS and non-nTMS groups, respectively, remained unchanged and 13% and 18% of patients in the nTMS and non-nTMS groups, respectively, deteriorated in postoperative motor function on long-term follow-up (p=0.0057). Moreover, the nTMS group showed smaller craniotomies (nTMS 22.4 ± 8.3 cm2; non-nTMS 26.7 ± 11.3 cm2; p=0.0023).

Conclusions: This is the first study to actually prove the value of preoperative motor mapping by nTMS for rolandic lesions in a group comparison study. This work therefore increases the level of evidence for this new modality and we strongly advocate nTMS to become increasingly used for these lesions.