TY - JOUR
T1 - A comparison of language mapping by preoperative navigated transcranial magnetic stimulation and direct cortical stimulation during awake surgery
AU - Picht, Thomas
AU - Krieg, Sandro M.
AU - Sollmann, Nico
AU - Rösler, Judith
AU - Niraula, Birat
AU - Neuvonen, Tuomas
AU - Savolainen, Petri
AU - Lioumis, Pantelis
AU - Mäkelä, Jyrki P.
AU - Deletis, Vedran
AU - Meyer, Bernhard
AU - Vajkoczy, Peter
AU - Ringel, Florian
PY - 2013/5
Y1 - 2013/5
N2 - BACKGROUND:: Navigated transcranial magnetic stimulation (nTMS) is increasingly used in presurgical brain mapping. Preoperative nTMS results correlate well with direct cortical stimulation (DCS) data in the identification of the primary motor cortex. Repetitive nTMS can also be used for mapping of speech-sensitive cortical areas. OBJECTIVE:: The current cohort study compares the safety and effectiveness of preoperative nTMS with DCS mapping during awake surgery for the identification of language areas in patients with left-sided cerebral lesions. METHODS:: Twenty patients with tumors in or close to left-sided language eloquent regions were examined by repetitive nTMS before surgery. During awake surgery, language-eloquent cortex was identified by DCS. nTMS results were compared for accuracy and reliability with regard to DCS by projecting both results into the cortical parcellation system. RESULTS:: Presurgical nTMS maps showed an overall sensitivity of 90.2%, specificity of 23.8%, positive predictive value of 35.6%, and negative predictive value of 83.9% compared with DCS. For the anatomic Broca's area, the corresponding values were a sensitivity of 100%, specificity of 13.0%, positive predictive value of 56.5%, and negative predictive value of 100%, respectively. CONCLUSION:: Good overall correlation between repetitive nTMS and DCS was observed, particularly with regard to negatively mapped regions. Noninvasive inhibition mapping with nTMS is evolving as a valuable tool for preoperative mapping of language areas. Yet its low specificity in posterior language areas in the current study necessitates further research to refine the methodology. ABBREVIATIONS:: DCS, direct cortical stimulationfMRI, functional magnetic resonance imagingnTMS, navigated transcranial magnetic stimulationRMT, resting motor thresholdrTMS, repetitive transcranial magnetic stimulationTMS, transcranial magnetic stimulation.
AB - BACKGROUND:: Navigated transcranial magnetic stimulation (nTMS) is increasingly used in presurgical brain mapping. Preoperative nTMS results correlate well with direct cortical stimulation (DCS) data in the identification of the primary motor cortex. Repetitive nTMS can also be used for mapping of speech-sensitive cortical areas. OBJECTIVE:: The current cohort study compares the safety and effectiveness of preoperative nTMS with DCS mapping during awake surgery for the identification of language areas in patients with left-sided cerebral lesions. METHODS:: Twenty patients with tumors in or close to left-sided language eloquent regions were examined by repetitive nTMS before surgery. During awake surgery, language-eloquent cortex was identified by DCS. nTMS results were compared for accuracy and reliability with regard to DCS by projecting both results into the cortical parcellation system. RESULTS:: Presurgical nTMS maps showed an overall sensitivity of 90.2%, specificity of 23.8%, positive predictive value of 35.6%, and negative predictive value of 83.9% compared with DCS. For the anatomic Broca's area, the corresponding values were a sensitivity of 100%, specificity of 13.0%, positive predictive value of 56.5%, and negative predictive value of 100%, respectively. CONCLUSION:: Good overall correlation between repetitive nTMS and DCS was observed, particularly with regard to negatively mapped regions. Noninvasive inhibition mapping with nTMS is evolving as a valuable tool for preoperative mapping of language areas. Yet its low specificity in posterior language areas in the current study necessitates further research to refine the methodology. ABBREVIATIONS:: DCS, direct cortical stimulationfMRI, functional magnetic resonance imagingnTMS, navigated transcranial magnetic stimulationRMT, resting motor thresholdrTMS, repetitive transcranial magnetic stimulationTMS, transcranial magnetic stimulation.
KW - Awake surgery
KW - Language
KW - Preoperative mapping
KW - Transcranial magnetic stimulation
KW - Tumor
UR - http://www.scopus.com/inward/record.url?scp=84876697873&partnerID=8YFLogxK
U2 - 10.1227/NEU.0b013e3182889e01
DO - 10.1227/NEU.0b013e3182889e01
M3 - Article
C2 - 23385773
AN - SCOPUS:84876697873
SN - 0148-396X
VL - 72
SP - 808
EP - 819
JO - Neurosurgery
JF - Neurosurgery
IS - 5
ER -