The Impact of Diffusion Tensor Imaging Fiber Tracking of the Corticospinal Tract Based on Navigated Transcranial Magnetic Stimulation on Surgery of Motor-Eloquent Brain Lesions
| Autor: | Rosaria Viola Abbritti, Filippo Flavio Angileri, Giovanni Raffa, Alfredo Conti, Francesco Tomasello, Carmela Sindorio, Antonino Germanò, Antonino Scibilia, Felice Esposito, Salvatore Cardali, Domenico La Torre |
|---|---|
| Přispěvatelé: | Raffa, Giovanni, Conti, Alfredo, Scibilia, Antonino, Cardali, Salvatore Massimiliano, Esposito, Felice, Angileri, Filippo Flavio, La Torre, Domenico, Sindorio, Carmela, Abbritti, Rosaria Viola, Germanò, Antonino, Tomasello, Francesco |
| Jazyk: | angličtina |
| Rok vydání: | 2018 |
| Předmět: |
Adult
Male medicine.medical_specialty Intraoperative Neurophysiological Monitoring medicine.medical_treatment Pyramidal Tracts Preoperative care 030218 nuclear medicine & medical imaging 03 medical and health sciences 0302 clinical medicine Text mining Navigated transcranial magnetic stimulation medicine Humans Karnofsky Performance Status Brain tumors Corticospinal tract DTI tractography Eloquent areas Motor cortex Craniotomy Aged Retrospective Studies Brain Mapping Brain Neoplasms business.industry Eloquent area Retrospective cohort study Middle Aged Transcranial Magnetic Stimulation Surgery Transcranial magnetic stimulation Brain tumor Diffusion Tensor Imaging medicine.anatomical_structure Case-Control Studies Female Neurology (clinical) business 030217 neurology & neurosurgery Diffusion MRI |
| Popis: | Background Navigated transcranial magnetic stimulation (nTMS) enables preoperative mapping of the motor cortex (M1). The combination of nTMS with diffusion tensor imaging fiber tracking (DTI-FT) of the corticospinal tract (CST) has been described; however, its impact on surgery of motor-eloquent lesions has not been addressed. Objective To analyze the impact of nTMS-based mapping on surgery of motor-eloquent lesions. Methods In this retrospective case-control study, we reviewed the data of patients operated for suspected motor-eloquent lesions between 2012 and 2015. The patients underwent nTMS mapping of M1 and, from 2014, nTMS-based DTI-FT of the CST. The impact on the preoperative risk/benefit analysis, surgical strategy, craniotomy size, extent of resection (EOR), and outcome were compared with a control group. Results We included 35 patients who underwent nTMS mapping of M1 (group A), 35 patients who also underwent nTMS-based DTI-FT of the CST (group B), and a control group composed of 35 patients treated without nTMS (group C). The patients in groups A and B received smaller craniotomies (P = .01; P = .001), had less postoperative seizures (P = .02), and a better postoperative motor performance (P = .04) and Karnofsky Performance Status (P = .009) than the controls. Group B exhibited an improved risk/benefit analysis (P = .006), an increased EOR of nTMS-negative lesions in absence of preoperative motor deficits (P = .01), and less motor and Karnofsky Performance Status worsening in case of preoperative motor deficits (P = .02, P = .03) than group A. Conclusion nTMS-based mapping enables a tailored surgical approach for motor-eloquent lesions. It may improve the risk/benefit analysis, EOR and outcome, particularly when nTMS-based DTI-FT is performed. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|