Minim Invasive Neurosurg 2011; 54(1): 38-40
DOI: 10.1055/s-0031-1273732
Case Report

© Georg Thieme Verlag KG Stuttgart · New York

Navigated Transcranial Magnetic Stimulation-Guided Resection of a Left Parietal Tumor: Case Report

J. Coburger1 , C. Musahl1 , C. Weissbach1 , M. Bittl1
  • 1Department of Neurosurgery, Klinikum Stuttgart, Stuttgart, Germany
Further Information

Publication History

Publication Date:
19 April 2011 (online)

Abstract

Backround: Operating on tumors with close margins to the primary motor cortex requires a precise preoperative planning. Transcranial magnetic stimulation (TMS) is the only preoperative technique for detecting eloquent cortical regions that is directly comparable to direct cortical stimulation (DCS). Combining this well established method in neurological diagnostics with a non-invasive navigation system using the patient's preoperative MRI scans in the NEXTSTIM system might be a promising tool in preoperative planning.

Case Report: We used preoperative navigated TMS to localize the motor strip in a 75-year-old female patient with a central lesion suspected to be a meningeoma. The elicited data were fused to the navigation MRI in the Brainlab IPLAN system. Following the preoperatively acquired MEP data, a posterior approach to the tumor was planned. After craniotomy, DCS and phase reversal were performed to verify the preoperative results. The motor strip could be located in the same cortical area where the motor response was elicited preoperatively

Conclusion: Navigated transcranial cortical stimulation via the NEXTSTIM system is a helpful tool for preoperative planning.

References

  • 1 Reithmeier T, Krammer M, Gumprecht H, Lumenta CB. et al . Neuronavigation combined with electrophysiological monitoring for surgery of lesions in eloquent brain areas in 42 cases: a retrospective comparison of the neurological outcome and the quality of resection with a control group with similar lesions.  Minim Invas Neurosurg. 2003;  46 65-71
  • 2 Suess O, Suess S, Brock M. Intraoperative electrocortical stimulation of Brodman area 4: a 10-year analysis of 255 cases.  Head Face Med. 2006;  2 20
  • 3 Petrella JR, Shah LM, Harris KM. et al . Preoperative functional MR imaging localization of language and motor areas: effect on therapeutic decision making in patients with potentially resectable brain tumors 1.  Radiology. 2006;  240 793-802
  • 4 Iseki H, Nakamura R, Muragaki Y. et al . Advanced computer-aided intraoperative technologies for information-guided surgical management of gliomas: Tokyo Women's Medical University experience.  Minim Invas Neurosurg. 2008;  51 285-291
  • 5 Giussani C, Roux FE, Ojemann J. et al . Is preoperative functional magnetic resonance imaging reliable for language areas mapping in brain tumor surgery? Review of language functional magnetic resonance imaging and direct cortical stimulation correlation studies.  Neurosurgery. 2010;  66 113-120
  • 6 Ruohonen J, Karhu J. Navigated transcranial magnetic stimulation.  Neurophysiol Clin. 2010;  40 7-17

Correspondence

J. Coburger

Department of Neurosurgery

Klinikum Stuttgart

Kriegsbergstraße 60

70174 Stuttgart

Germany

Phone: +49/711/278 337 05

Fax: +49/711/278 320 09

Email: J.Coburger@klinikum-stuttgart.de

    >