Resection of motor eloquent metastases aided by preoperative nTMS-based motor maps-Comparison of two observational cohorts

Sandro M. Krieg, Thomas Picht, Nico Sollmann, Ina Bährend, Florian Ringel, Srikantan S. Nagarajan, Bernhard Meyer, Phiroz E. Tarapore

Research output: Contribution to journalArticlepeer-review

44 Scopus citations


Introduction: Preoperative mapping of motor areas with navigated transcranial magnetic stimulation (nTMS) has been shown to improve surgical outcomes for peri-Rolandic lesions and, in particular, for gliomas. However, the impact of this technique on surgical outcomes for peri-Rolandic metastatic lesions is yet unknown. Objective: To investigate the impact of nTMS on surgical outcomes for peri-Rolandic metastatic lesions, various clinical parameters were analyzed in our international study group. Methods: Two prospectively enrolled cohorts were compared by investigating patients receiving preoperative nTMS (2010-2015; 120 patients) and patients who did not receive preoperative nTMS (2006-2015; 130 patients). Tumor location, pathology, size, and preoperative deficits were comparable. Results: The nTMS group showed a lower rate of residual tumor on postoperative magnetic resonance imaging (odds ratio 0.3025; 95% confidence interval 0.1356-0.6749). On long-term follow-up, surgery-related paresis was decreased in the nTMS group (nTMS vs. non-nTMS; improved: 30.8 vs. 13.1%, unchanged: 65.8 vs. 73.8%, worse: 3.4 vs. 13.1% of patients; p = 0.0002). Moreover, the nTMS group received smaller craniotomies (nTMS: 16.7 ± 8.6 cm2 vs. non-nTMS: 25.0 ± 17.1 cm2; p < 0.0001). Surgical time differed significantly between the two groups (nTMS: 128.8 ± 49.4 min vs. non-nTMS: 158.0 ± 65.8 min; p = 0.0002). Conclusion: This non-randomized study suggests that preoperative motor mapping by nTMS may improve the treatment of patients undergoing surgical resection of metastases in peri-Rolandic regions. These findings suggest that further evaluation with a prospective, randomized trial may be warranted.

Original languageEnglish
Article number261
JournalFrontiers in Oncology
Issue numberDEC
StatePublished - 2016
Externally publishedYes


  • Brain metastases
  • Matched pair
  • Preoperative mapping
  • Rolandic region
  • Transcranial magnetic stimulation


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