Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Acta Neurochirurgica
Published in: Acta Neurochirurgica 12/2016

01-12-2016 | Original Article - Neurosurgical Techniques

Comparison between electric-field-navigated and line-navigated TMS for cortical motor mapping in patients with brain tumors

Authors: Nico Sollmann, Moritz F. Goblirsch-Kolb, Sebastian Ille, Vicki M. Butenschoen, Tobias Boeckh-Behrens, Bernhard Meyer, Florian Ringel, Sandro M. Krieg

Published in: Acta Neurochirurgica | Issue 12/2016

Login to get access

Abstract

Background

For the navigation of transcranial magnetic stimulation (TMS), various techniques are available. Yet, there are two basic principles underlying them all: electric-field-navigated transcranial magnetic stimulation (En-TMS) and line-navigated transcranial magnetic stimulation (Ln-TMS). The current study was designed to compare both methods.

Methods

To explore whether there is a difference in clinical applicability, workflow, and mapping results of both techniques, we systematically compared motor mapping via En-TMS and Ln-TMS in 12 patients suffering from brain tumors.

Results

The number of motor-positive stimulation spots and the ratio of positive spots per overall stimulation numbers were significantly higher for En-TMS (motor-positive spots: En-TMS vs. Ln-TMS: 128.3 ± 35.0 vs. 41.3 ± 26.8, p < 0.0001; ratio of motor-positive spots per number of stimulations: En-TMS vs. Ln-TMS: 38.0 ± 9.2 % vs. 20.0 ± 14.4 %, p = 0.0031). Distances between the En-TMS and Ln-TMS motor hotspots were 8.3 ± 4.4 mm on the ipsilesional and 8.6 ± 4.5 mm on the contralesional hemisphere (p = 0.9124).

Conclusions

The present study compares En-TMS and Ln-TMS motor mapping in the neurosurgical context for the first time. Although both TMS systems tested in the present study are explicitly designed for application during motor mapping in patients with brain lesions, there are differences in applicability, workflow, and results between En-TMS and Ln-TMS, which should be distinctly considered during clinical use of the technique. However, to draw final conclusions about accuracy, confirmation of motor-positive Ln-TMS spots by intraoperative stimulation is crucial within the scope of upcoming investigations.
Literature
1.
Ahdab R, Ayache SS, Brugieres P, Farhat WH, Lefaucheur JP (2016) The Hand Motor Hotspot is not Always Located in the Hand Knob: A Neuronavigated Transcranial Magnetic Stimulation Study. Brain Topogr 29:590–597CrossRefPubMed
2.
Babajani-Feremi A, Narayana S, Rezaie R, Choudhri AF, Fulton SP, Boop FA, Wheless JW, Papanicolaou AC (2016) Language mapping using high gamma electrocorticography, fMRI, and TMS versus electrocortical stimulation. Clin Neurophysiol: Off J Int Fed Clin Neurophysiol 127:1822–1836CrossRef
3.
Bijsterbosch JD, Barker AT, Lee KH, Woodruff PW (2012) Where does transcranial magnetic stimulation (TMS) stimulate? Modelling of induced field maps for some common cortical and cerebellar targets. Med Biol Eng Comput 50:671–681CrossRefPubMed
4.
Brasil-Neto JP, Cohen LG, Panizza M, Nilsson J, Roth BJ, Hallett M (1992) Optimal focal transcranial magnetic activation of the human motor cortex: effects of coil orientation, shape of the induced current pulse, and stimulus intensity. J Clin Neurophysiol 9:132–136CrossRefPubMed
5.
Bulubas L, Sabih J, Wohlschlaeger A, Sollmann N, Hauck T, Ille S, Ringel F, Meyer B, Krieg SM (2016) Motor areas of the frontal cortex in patients with motor eloquent brain lesions. J Neurosurg:1–12
6.
Conti A, Raffa G, Granata F, Rizzo V, Germano A, Tomasello F (2014) Navigated transcranial magnetic stimulation for "somatotopic" tractography of the corticospinal tract. Neurosurgery 10(Suppl 4):542–554, discussion 554CrossRefPubMed
7.
Danner N, Kononen M, Saisanen L, Laitinen R, Mervaala E, Julkunen P (2012) Effect of individual anatomy on resting motor threshold-computed electric field as a measure of cortical excitability. J Neurosci Methods 203:298–304CrossRefPubMed
8.
Forster MT, Hattingen E, Senft C, Gasser T, Seifert V, Szelenyi A (2011) Navigated transcranial magnetic stimulation and functional magnetic resonance imaging: advanced adjuncts in preoperative planning for central region tumors. Neurosurgery 68:1317–1324, discussion 1324–1315PubMed
9.
Forster MT, Hoecker AC, Kang JS, Quick J, Seifert V, Hattingen E, Hilker R, Weise LM (2015) Does navigated transcranial stimulation increase the accuracy of tractography? A prospective clinical trial based on intraoperative motor evoked potential monitoring during deep brain stimulation. Neurosurgery 76:766–775, discussion 775–766CrossRefPubMed
10.
Forster MT, Senft C, Hattingen E, Lorei M, Seifert V, Szelenyi A (2012) Motor cortex evaluation by nTMS after surgery of central region tumors: a feasibility study. Acta Neurochir (Wien) 154:1351–1359CrossRefPubMed
11.
Frey D, Strack V, Wiener E, Jussen D, Vajkoczy P, Picht T (2012) A new approach for corticospinal tract reconstruction based on navigated transcranial stimulation and standardized fractional anisotropy values. NeuroImage 62:1600–1609CrossRefPubMed
12.
Julkunen P, Saisanen L, Danner N, Niskanen E, Hukkanen T, Mervaala E, Kononen M (2009) Comparison of navigated and non-navigated transcranial magnetic stimulation for motor cortex mapping, motor threshold and motor evoked potentials. Neuroimage 44:790–795CrossRefPubMed
13.
Kallioniemi E, Pitkanen M, Saisanen L, Julkunen P (2015) Onset Latency of Motor Evoked Potentials in Motor Cortical Mapping with Neuronavigated Transcranial Magnetic Stimulation. The Open Neurol J 9:62–69CrossRefPubMed
14.
Kantelhardt SR, Fadini T, Finke M, Kallenberg K, Siemerkus J, Bockermann V, Matthaeus L, Paulus W, Schweikard A, Rohde V, Giese A (2010) Robot-assisted image-guided transcranial magnetic stimulation for somatotopic mapping of the motor cortex: a clinical pilot study. Acta Neurochir 152:333–343CrossRefPubMed
15.
Karhu J, Hannula H, Laine J, Ruohonen J (2014) Navigated Transcranial Magnetic Stimulation: Principles and Protocol for Mapping the Motor Cortex. 89:337–359
16.
Keller SS, Highley JR, Garcia-Finana M, Sluming V, Rezaie R, Roberts N (2007) Sulcal variability, stereological measurement and asymmetry of Broca’s area on MR images. J Anat 211:534–555PubMedPubMedCentral
17.
Krieg SM, Buchmann NH, Gempt J, Shiban E, Meyer B, Ringel F (2012) Diffusion tensor imaging fiber tracking using navigated brain stimulation—a feasibility study. Acta Neurochir 154:555–563CrossRefPubMed
18.
Krieg SM, Shiban E, Buchmann N, Gempt J, Foerschler A, Meyer B, Ringel F (2012) Utility of presurgical navigated transcranial magnetic brain stimulation for the resection of tumors in eloquent motor areas. J Neurosurg 116:994–1001CrossRefPubMed
19.
Krieg SM, Shiban E, Buchmann N, Meyer B, Ringel F (2013) Presurgical navigated transcranial magnetic brain stimulation for recurrent gliomas in motor eloquent areas. Clin Neurophysiol: Off J Int Fed Clin Neurophysiol 124:522–527CrossRef
20.
Krings T, Buchbinder BR, Butler WE, Chiappa KH, Jiang HJ, Rosen BR, Cosgrove GR (1997) Stereotactic transcranial magnetic stimulation: correlation with direct electrical cortical stimulation. Neurosurgery 41:1319–1325, discussion 1325–1316CrossRefPubMed
21.
Niskanen E, Julkunen P, Saisanen L, Vanninen R, Karjalainen P, Kononen M (2010) Group-level variations in motor representation areas of thenar and anterior tibial muscles: Navigated Transcranial Magnetic Stimulation Study. Hum Brain Mapp 31:1272–1280PubMed
22.
Ottenhausen M, Krieg SM, Meyer B, Ringel F (2015) Functional preoperative and intraoperative mapping and monitoring: increasing safety and efficacy in glioma surgery. Neurosurg Focus 38:E3CrossRefPubMed
23.
Park MC, Goldman MA, Park MJ, Friehs GM (2007) Neuroanatomical localization of the ‘precentral knob’ with computed tomography imaging. Stereotact Funct Neurosurg 85:158–161CrossRefPubMed
24.
Picht T (2014) Current and potential utility of transcranial magnetic stimulation in the diagnostics before brain tumor surgery. CNS Oncol 3:299–310CrossRefPubMed
25.
Picht T, Mularski S, Kuehn B, Vajkoczy P, Kombos T, Suess O (2009) Navigated transcranial magnetic stimulation for preoperative functional diagnostics in brain tumor surgery. Neurosurgery 65:93–98, discussion 98–99CrossRefPubMed
26.
Rossi S, Hallett M, Rossini PM, Pascual-Leone A, Safety of TMSCG (2009) Safety, ethical considerations, and application guidelines for the use of transcranial magnetic stimulation in clinical practice and research. Clin Neurophysiol: Off J Int Fed Clin Neurophysiol 120:2008–2039CrossRef
27.
Rossini PM, Burke D, Chen R, Cohen LG, Daskalakis Z, Di Iorio R, Di Lazzaro V, Ferreri F, Fitzgerald PB, George MS, Hallett M, Lefaucheur JP, Langguth B, Matsumoto H, Miniussi C, Nitsche MA, Pascual-Leone A, Paulus W, Rossi S, Rothwell JC, Siebner HR, Ugawa Y, Walsh V, Ziemann U (2015) Non-invasive electrical and magnetic stimulation of the brain, spinal cord, roots and peripheral nerves: Basic principles and procedures for routine clinical and research application. An updated report from an I.F.C.N. Committee. Clin Neurophysiol: Off J Int Fed Clin Neurophysiol 126:1071–1107CrossRef
28.
Ruohonen J, Ilmoniemi RJ (1999) Modeling of the stimulating field generation in TMS. Electroencephalogr Clin Neurophysiol Suppl 51:30–40PubMed
29.
Ruohonen J, Karhu J (2010) Navigated transcranial magnetic stimulation. Neurophysiol Clin = Clin Neurophysiol 40:7–17CrossRef
30.
Saisanen L, Julkunen P, Niskanen E, Danner N, Hukkanen T, Lohioja T, Nurkkala J, Mervaala E, Karhu J, Kononen M (2008) Motor potentials evoked by navigated transcranial magnetic stimulation in healthy subjects. J Clin Neurophysiol: Off Publ Am Electroencephalographic Soc 25:367–372CrossRef
31.
Schmidt S, Bathe-Peters R, Fleischmann R, Ronnefarth M, Scholz M, Brandt SA (2015) Nonphysiological factors in navigated TMS studies; confounding covariates and valid intracortical estimates. Hum Brain Mapp 36:40–49CrossRefPubMed
32.
Sollmann N, Hauck T, Obermuller T, Hapfelmeier A, Meyer B, Ringel F, Krieg SM (2013) Inter- and intraobserver variability in motor mapping of the hotspot for the abductor policis brevis muscle. BMC Neurosci 14:94CrossRefPubMedPubMedCentral
33.
Takahashi S, Vajkoczy P, Picht T (2013) Navigated transcranial magnetic stimulation for mapping the motor cortex in patients with rolandic brain tumors. Neurosurg Focus 34:E3CrossRefPubMed
34.
Tarapore PE, Findlay AM, Honma SM, Mizuiri D, Houde JF, Berger MS, Nagarajan SS (2013) Language mapping with navigated repetitive TMS: proof of technique and validation. NeuroImage 82:260–272CrossRefPubMed
35.
Tarapore PE, Picht T, Bulubas L, Shin Y, Kulchytska N, Meyer B, Berger MS, Nagarajan SS, Krieg SM (2016) Safety and tolerability of navigated TMS for preoperative mapping in neurosurgical patients. Clin Neurophysiol: Off J Int Fed Clin Neurophysiol 127:1895–1900CrossRef
36.
Tarapore PE, Tate MC, Findlay AM, Honma SM, Mizuiri D, Berger MS, Nagarajan SS (2012) Preoperative multimodal motor mapping: a comparison of magnetoencephalography imaging, navigated transcranial magnetic stimulation, and direct cortical stimulation. J Neurosurg 117:354–362CrossRefPubMedPubMedCentral
37.
Weiss C, Tursunova I, Neuschmelting V, Lockau H, Nettekoven C, Oros-Peusquens AM, Stoffels G, Rehme AK, Faymonville AM, Shah NJ, Langen KJ, Goldbrunner R, Grefkes C (2015) Improved nTMS- and DTI-derived CST tractography through anatomical ROI seeding on anterior pontine level compared to internal capsule. NeuroImage Clin 7:424–437CrossRefPubMedPubMedCentral
38.
Yousry TA, Schmid UD, Alkadhi H, Schmidt D, Peraud A, Buettner A, Winkler P (1997) Localization of the motor hand area to a knob on the precentral gyrus. A new landmark. Brain: J Neurol 120(Pt 1):141–157CrossRef
39.
Zdunczyk A, Fleischmann R, Schulz J, Vajkoczy P, Picht T (2013) The reliability of topographic measurements from navigated transcranial magnetic stimulation in healthy volunteers and tumor patients. Acta Neurochir (Wien) 155:1309–1317CrossRef
Metadata
Title
Comparison between electric-field-navigated and line-navigated TMS for cortical motor mapping in patients with brain tumors
Authors
Nico Sollmann
Moritz F. Goblirsch-Kolb
Sebastian Ille
Vicki M. Butenschoen
Tobias Boeckh-Behrens
Bernhard Meyer
Florian Ringel
Sandro M. Krieg
Publication date
01-12-2016
Publisher
Springer Vienna
Published in
Acta Neurochirurgica / Issue 12/2016
Print ISSN: 0001-6268
Electronic ISSN: 0942-0940
DOI
https://doi.org/10.1007/s00701-016-2970-6

Other articles of this Issue 12/2016

Acta Neurochirurgica 12/2016 Go to the issue

Editorial (by Invitation)

Philosophical aspects of body transplantation

Clinical Article - Brain Injury

Can early clinical parameters predict post-traumatic pituitary dysfunction in severe traumatic brain injury?

Experimental Research - Functional

Factors predicting the outcome following surgical treatment of mesial temporal epilepsy due to mesial temporal sclerosis

Clinical Article - Vascular

Perioperative stroke after carotid endarterectomy: etiology and implications

Case Report - Functional

Deep brain stimulation could cause delayed and recurrent cerebral ischemia: a case report

Clinical Article - Neurosurgical Techniques

The value of 3D-FIESTA MRI in detecting non-iatrogenic cerebrospinal fluid rhinorrhoea: correlations with endoscopic endonasal surgery