| Autor: |
Bonaudo, Camilla, Castaldi, Elisa, Pedone, Agnese, Capelli, Federico, Enderage Don, Shani, Pieropan, Edoardo, Bianchi, Andrea, Gobbo, Marika, Maduli, Giuseppe, Fedi, Francesca, Baldanzi, Fabrizio, Troiano, Simone, Maiorelli, Antonio, Muscas, Giovanni, Battista, Francesca, Campagnaro, Luca, De Pellegrin, Serena, Amadori, Andrea, Fainardi, Enrico, Carrai, Riccardo |
| Zdroj: |
Cancers; Dec2024, Vol. 16 Issue 24, p4250, 16p |
| Abstrakt: |
Simple Summary: Visuospatial circuits (VS) must be preserved during brain tumours' excision. Navigated TMS is a valid tool to preoperatively map VS networks and to optimise functional preservation. In this work, we tested 27 patients with nTMS preoperative mapping and an experimental test for VS abilities, called VISA, demonstrating a good clinical outcome (functional recovery 80–98.86%) and a useful nTMS map for tractography reconstruction (with the main involvement of the second and the third branches of the superior longitudinal fasciculus). Finally, a comparison of nTMS and DCS points in awake surgery (n = 10 patients) documented a sensitivity (Se) of 12%, a specificity (Sp) of 91.21%, a positive predictive value (PPV) of 42%, a negative predictive value (NPV) of 66%, and an accuracy of ~63.7%. According to our preliminary results, nTMS is advantageous to study cognitive functions, minimising neurological impairment. Further analyses are needed to validate our data. Objective: Navigated transcranial magnetic stimulation (nTMS) has seldom been used to study visuospatial (VS) circuits so far. Our work studied (I) VS functions in neurosurgical oncological patients by using repetitive nTMS (rnTMS), (II) the possible subcortical circuits underneath, and (III) the correspondence between nTMS and direct cortical stimulation (DCS) during awake procedures. Methods: We designed a monocentric prospective study, adopting a protocol to use rnTMS for preoperative planning, including VS functions for lesions potentially involving the VS network, including neurosurgical awake and asleep procedures. nTMS-based-DTI tractography allowed the visualization of subcortical circuits. Statistical analyses on nTMS/DCS points were performed. Clinical results were collected pre- and postoperatively. Results: Finally, 27 patients with primitive intra-axial brain lesions were enrolled between April 2023 and March 2024. Specific tests and an experimental integrated VS test (VISA) were used. The clinical evaluation (at 5 ± 7, 30 ± 10, 90 ± 10 days after surgery) documented 33% of patients with neglect in the left hemisphere four days after surgery and, during the 3-month follow-up, preservation of visuospatial function/clinical recovery (90.62% in MMSE, 98.86% in the bell test, 80% in the clock test, and 98% in the OCS test). The surgical strategy was modulated according to the nTMS map. Subcortical bundles were traced to identify those most involved in these functions: SFLII > SLFII > SLFI. A comparison of the nTMS and DCS points in awake surgery (n = 10 patients) documented a sensitivity (Se) of 12%, a specificity (Sp) of 91.21%, a positive predictive value (PPV) of 42%, a negative predictive value (NPV) of 66%, and an accuracy of ~63.7%. Conclusions: Based on our preliminary results, nTMS is advantageous for studying cognitive functions, minimising neurological impairment. Further analyses are needed to validate our data. [ABSTRACT FROM AUTHOR] |
| Databáze: |
Complementary Index |
| Externí odkaz: |
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