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Navigierte transkranielle Magnetstimulation für präoperatives Mapping eloquenter Kortexareale

Navigated transcranial magnetic stimulation for preoperative mapping of the eloquent cortex

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Zusammenfassung

Hintergrund

Hirntumoroperationen in funktionell relevanten Arealen (eloquenter Kortex) stellen eine besondere Herausforderung dar. Das präoperative funktionelle Mapping mit der navigierten transkraniellen Magnetstimulation (nTMS) wurde im Jahr 2009 in die präoperative Routinediagnostik eingeführt und hat seitdem zunehmend an Bedeutung gewonnen.

Fragestellung

Genauigkeit und Zuverlässigkeit des Motor- und Sprachmappings mittels nTMS und Darstellung der klinischen Relevanz.

Material und Methode

Auswertung der publizierten Arbeiten und Diskussion der Ergebnisse.

Ergebnisse

Für das motorische TMS-Mapping gilt, dass sowohl TMS-positive (motorische Antworten werden ausgelöst) als auch -negative kortikale Punkte für die Operationsplanung und die intraoperative Entscheidungsfindung herangezogen werden können. TMS-positive Sprachmappingpunkte (Störungen der Sprachfunktion werden ausgelöst) können zur Operationsplanung beitragen, sollten zurzeit aber noch intraoperativ mittels direkter elektrischer Stimulation überprüft werden. Negatives TMS-Sprachmapping (Sprachfunktionen werden durch die Stimulation nicht gestört) korreliert gut mit dem Goldstandard der intraoperativen Testung. Aktuelle Studien weisen eine Verbesserung des chirurgischen Behandlungsergebnisses nach präoperativer TMS-Diagnostik nach.

Schlussfolgerung

Patienten mit Hirntumoren in eloquenten Arealen sollten vor einer möglichen Operation basierend auf zuverlässigen funktionellen Mappingdaten beraten werden. Die TMS stellt eine valide nichtinvasive Methode zur Erstellung der notwendigen funktionellen Kartographien dar.

Summary

Background

Brain tumor surgery in functionally relevant areas is particularly challenging. Preoperative functional mapping with navigated transcranial magnetic stimulation (TMS) was introduced into the clinical routine in 2009 and since then has seen widespread adoption.

Objectives

Accuracy and consistency of TMS motor and language mapping and its clinical relevance.

Methods

Analysis of published scientific papers and discussion of the findings.

Results

Positive (i.e. motor responses are elicited) and negative cortical points for TMS motor mapping can be used for treatment planning and intraoperative decision making. Language mapping points (disruption of language function) positive in TMS can support treatment planning but should be confirmed intraoperatively with direct electrical stimulation. Negative TMS language mapping (language functions are not disrupted) correlates well with the gold standard of intraoperative testing. Recent studies reported improved treatment outcome after preoperative TMS mapping.

Conclusion

Patients suffering from brain tumors in eloquent locations should be counseled based on individual functional mapping data before surgery and TMS is a valid non-invasive methodology which can provide such functional mapping.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. T. Picht gibt an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Authors and Affiliations

  1. Neurochirurgische Klinik, Charité – Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Deutschland

    T. Picht

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Picht, T. Navigierte transkranielle Magnetstimulation für präoperatives Mapping eloquenter Kortexareale. Nervenarzt 86, 1508–1515 (2015). https://doi.org/10.1007/s00115-015-4316-7

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