Surgical treatment of meningiomas located in the rolandic area: the role of navigated transcranial magnetic stimulation for preoperative planning, surgical strategy, and prediction of arachnoidal cleavage and motor outcome
| Autor: | Alfredo Conti, Antonino Germanò, Johannes Rein, Judith Rösler, Giuseppe Ricciardo, Salvatore Cardali, Peter Vajkoczy, Antonino Scibilia, Giovanni Raffa, Thomas Picht |
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| Přispěvatelé: | Raffa, Giovanni, Picht, Thoma, Scibilia, Antonino, Rösler, Judith, Rein, Johanne, Conti, Alfredo, Ricciardo, Giuseppe, Cardali, Salvatore Massimiliano, Vajkoczy, Peter, Germanò, Antonino |
| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
Surgical strategy medicine.medical_treatment CST = corticospinal tract DTI = diffusion tensor imaging DTI fiber tracking DTI-FT = DTI fiber tracking DWI = diffusion-weighted imaging FDI = first dorsal interosseus IONM = intraoperative neurophysiological mapping MRC = Medical Research Council MSO = maximum stimulator output NPV = negative predictive value PPV = positive predictive value RMT = resting motor threshold brain tumors eloquent areas meningiomas nTMS = navigated transcranial magnetic stimulation navigated transcranial magnetic stimulation oncology preoperative planning meningioma 03 medical and health sciences 0302 clinical medicine medicine Surgical treatment FDI = first dorsal interosseu eloquent area Preoperative planning business.industry General Medicine nervous system diseases body regions Transcranial magnetic stimulation medicine.anatomical_structure 030220 oncology & carcinogenesis Corticospinal tract Radiology Motor Deficit business human activities brain tumor 030217 neurology & neurosurgery Diffusion MRI Motor cortex |
| Zdroj: | Journal of Neurosurgery. 133:107-118 |
| ISSN: | 1933-0693 0022-3085 |
| DOI: | 10.3171/2019.3.jns183411 |
| Popis: | OBJECTIVESurgical treatment of convexity meningiomas is usually considered a low-risk procedure. Nevertheless, the risk of postoperative motor deficits is higher (7.1%–24.7% of all cases) for lesions located in the rolandic region, especially when an arachnoidal cleavage plane with the motor pathway is not identifiable. The authors analyzed the possible role of navigated transcranial magnetic stimulation (nTMS) for planning resection of rolandic meningiomas and predicting the presence or lack of an intraoperative arachnoidal cleavage plane as well as the postoperative motor outcome.METHODSClinical data were retrospectively collected from surgical cases involving patients affected by convexity, parasagittal, or falx meningiomas involving the rolandic region, who received preoperative nTMS mapping of the motor cortex (M1) and nTMS-based diffusion tensor imaging (DTI) fiber tracking of the corticospinal tract before surgery at 2 different neurosurgical centers. Surgeons’ self-reported evaluation of the impact of nTMS-based mapping on surgical strategy was analyzed. Moreover, the nTMS mapping accuracy was evaluated in comparison with intraoperative neurophysiological mapping (IONM). Lastly, we assessed the role of nTMS as well as other pre- and intraoperative parameters for predicting the patients’ motor outcome and the presence or absence of an intraoperative arachnoidal cleavage plane.RESULTSForty-seven patients were included in this study. The nTMS-based planning was considered useful in 89.3% of cases, and a change of the surgical strategy was observed in 42.5% of cases. The agreement of nTMS-based planning and IONM-based strategy in 35 patients was 94.2%. A new permanent motor deficit occurred in 8.5% of cases (4 of 47). A higher resting motor threshold (RMT) and the lack of an intraoperative arachnoidal cleavage plane were the only independent predictors of a poor motor outcome (p = 0.04 and p = 0.02, respectively). Moreover, a higher RMT and perilesional edema also predicted the lack of an arachnoidal cleavage plane (p = 0.01 and p = 0.03, respectively). Preoperative motor status, T2 cleft sign, contrast-enhancement pattern, and tumor volume had no predictive value.CONCLUSIONSnTMS-based motor mapping is a useful tool for presurgical assessment of rolandic meningiomas, especially when a clear cleavage plane with M1 is not present. Moreover, the RMT can indicate the presence or absence of an intraoperative cleavage plane and predict the motor outcome, thereby helping to identify high-risk patients before surgery. |
| Databáze: | OpenAIRE |
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