Journal
TRENDS IN RECONSTRUCTIVE NEUROSURGERY: NEUROREHABILITATION, RESTORATION AND RECONSTRUCTION
Volume 124, Issue -, Pages 251-261Publisher
SPRINGER INTERNATIONAL PUBLISHING AG
DOI: 10.1007/978-3-319-39546-3_37
Keywords
Arcuate fasciculus; Brain tumors; Corticospinal tract; DTI tractography; Low-grade gliomas; Navigated transcranial magnetic stimulation
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Background Surgery of low-grade gliomas (LGGs) in eloquent areas still presents a challenge. New technologies have been introduced to enable the performance of functional, customized preoperative planning aimed at maximal resection, while reducing the risk of postoperative deficits. We describe our experience in the surgery of LGGs in eloquent areas using preoperative planning based on navigated transcranial magnetic stimulation (nTMS) and diffusion tensor imaging (DTI) tractography. Methods Sixteen patients underwent preoperative planning, using nTMS and nTMS-based DTI tractography. Motor and language functions were mapped. Preoperative data allowed for tailoring of the surgical strategy. The impact of these modalities on surgical planning was evaluated. Influence on func-tional outcome was analyzed in comparison with results in a historical control group. Results In 12 patients (75 %), nTMS added useful information on functional anatomy and surgical risks. Surgical strategy was modified in 9 of 16 cases (56 %). The nTMS functional approach provided a good outcome at discharge, with a decrease in postoperative motor and/or language deficits, as compared with controls (6 vs. 44 %; p = 0.03). Conclusions The functional preoperative mapping of speech and motor pathways based on nTMS and DTI tractography provided useful information, allowing us to plan the best surgical strategy for radical resection; this resulted in improved postoperative neurological results.
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