Appliance of Navigated Transcranial Magnetic Stimulation in Radiosurgery for Brain Metastases.

Autor:	Tokarev AS; Sklifosovsky Research Institute of Emergency Care, Moscow, Russia., Rak VA; Sklifosovsky Research Institute of Emergency Care, Moscow, Russia., Sinkin MV; Sklifosovsky Research Institute of Emergency Care, Moscow, Russia., Evdokimova OL; Sklifosovsky Research Institute of Emergency Care, Moscow, Russia., Stepanov VN; Sklifosovsky Research Institute of Emergency Care, Moscow, Russia., Koynash GV; Sklifosovsky Research Institute of Emergency Care, Moscow, Russia., Krieg SM; Department of Neurosurgery, Klinikum Rechts der Isar, Technical University Munich, Munich, Germany; and., Krylov VV; Sklifosovsky Research Institute of Emergency Care, Moscow, Russia.; A.I. Yevdokimov, Moscow State University of Medicine and Dentistry, Moscow, Russia.
Jazyk:	angličtina
Zdroj:	Journal of clinical neurophysiology : official publication of the American Electroencephalographic Society [J Clin Neurophysiol] 2020 Jan; Vol. 37 (1), pp. 50-55.
DOI:	10.1097/WNP.0000000000000621
Abstrakt:	Purpose: Navigated transcranial magnetic stimulation (nTMS) provides noninvasive visualization of eloquent brain areas. The nTMS is usually applied in presurgical planning to minimize the risk of surgery-related neurological deterioration. The aim of this study was to evaluate the usefulness of nTMS data for GammaKnife treatment planning for patients suffering from brain metastases. Methods: Motor cortex mapping with nTMS was performed in eight patients with brain metastases within or adjacent to the precentral gyrus. The nTMS data set was imported into the planning software and fused with anatomical MRI. Then contouring of the target and critical structures was performed. Treatment plans with and without visualization of the functional structures by nTMS were analyzed and compared by neurosurgeon and medical physicist. Results: The primary motor cortex was successfully delineated even in all cases despite significant peritumoral edema. Beam shaping and combined isocenters were used for conformal dose distribution and steeper dose fall-off near the identified eloquent zone. Compared with plans without nTMS data, treatment plans with integration of cortical nTMS mapping data showed a 2% to 78% (mean, 35.2% ± 22.7%) lower 12-Gy volume within the motor cortex without reduction of the dose applied to the tumor. Conclusions: The presented approach allows the easy and reliable integration of neurophysiological mapping data into GammaKnife treatment plans by the standard GammaPlan software. Diminishing the dose to critical structures might help to minimize side effects and therefore improve quality of life for brain metastasis patients.
Databáze:	MEDLINE
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