Präoperative und intraoperative Funktionslokalisierung bei eloquenten Metastasen

Background. The introduction of preoperative mapping by navigated transcranial magnetic stimulation (nTMS) and intraoperative neuromonitoring (IONM) by motor-evoked potentials (MEP) allows the localization of the motor cortex and surveillance of the integrity of the motor system during metastases resection. Objective. This article provides an overview on recent techniques for multimodal functional mapping and monitoring of the motor system for surgical resection of metastases located in eloquent motor areas of the brain. Material and methods. The current literature was reviewed with regard to data on nTMS and IONM and key publications are described. Personal cases of the authors are used for better illustration and to increase the comprehensiveness of the topic. Results. In several studies nTMS was proven to show a good correlation with intraoperative direct cortical stimulation as the gold standard. Concerning IONM by MEPs there are recent data which show that MEP changes correlate well with postoperative motor deficits. Conclusion. For nTMS as well as for IONM there are sufficient data to justify their routine use in a multimodal setup for the resection of metastases located in eloquent motor areas of the brain.