Abstract
Navigated transcranial magnetic stimulation (nTMS) has been developed to make the induced electric field visible to the operator when targeting anatomical loci in the cortex. Since its introduction in 1985, TMS has offered the scientist a unique way to stimulate the brain, but the lack of accurate knowledge about the stimulated cortical spot and the stimulation intensity at the target area has compromised reproducibility and reliability, therefore limiting the clinical value of the technique. The majority of functional brain imaging tools indicate all brain areas that participate in a given task. Especially when there are structural and vascular changes in the brain after disease or trauma, indirect neuroimaging methods are sensitive to artifacts limiting their reliability in clinical routine work. TMS can evoke directly measurable physiological responses that produce maps from only those cortical spots that are mandatory for the observed reaction. The technological development that has enabled the stimulating electric field of the nTMS system to be calculated and visualized online for the operator has made nTMS particularly suitable for mapping the cortical motor and language areas for assessing the functional status of the cortical areas and tracts both in normal subjects and in patients.
In this chapter, we review and explore the physical and technical background of TMS and especially the electric field-navigated TMS that has enabled clinical applications in neurosurgery.
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References
Amassian VE, Eberle L, Maccabee PJ, Cracco RQ. Modelling magnetic coil excitation of human cerebral cortex with a peripheral nerve submersed in a brain shaped volume conductor: the significance of fiber-bending excitation. Electroencephalogr Clin Neurophysiol. 1992;77:390–401.
Barker AT, Jalinous R, Freeston IL. Non-invasive magnetic stimulation of human motor cortex. The Lancet. 1985;325:1106–7.
Danner N, Julkunen P, Könönen M, Säisänen L, Nurkkala J, Karhu J. Navigated transcranial magnetic stimulation and computed electric field strength reduce stimulator-dependent differences in the motor threshold. J Neurosci Methods. 2008;174:116–22.
Deng Z-D, Lisanby SH, Peterchev AV. Electric field depth-focality tradeoff in transcranial magnetic stimulation: simulation comparison of 50 coil designs. Brain Stimul. 2013;6:1–13.
FDA, Glossary of Computer System Software Development Terminology (8/95); 1995. www.fda.gov/iceci/inspections/inspectionguides/ucm074875.htm.
Forster MT, Hattingen E, Senft C, Gasser T, Seifert V, Szelenyi A. Navigated transcranial magnetic stimulation and functional magnetic resonance imaging: Advanced adjuncts in preoperative planning for central region tumors. Neurosurgery. 2011;68:1317–24. Discussion 1324–5.
Fox P, Ingham R, George MS, Mayberg H, Ingham J, Roby J, Martin C, Jerabek P. Imaging human intra‐cerebral connectivity by PET during TMS. Neuroreport. 1997;8:2787–91.
Grover FW. Inductance calculations. New York: Van Norstrand Company inc.; 1946.
Hannula H, Ylioja S, Pertovaara A, Korvenoja A, Ruohonen J, Ilmoniemi RJ, Carlson S. Somatotopic blocking of sensation with navigated transcranial magnetic stimulation of the primary somatosensory cortex. Hum Brain Mapp. 2005;26:100–9.
Ilmoniemi RJ, Grandori F. Device for applying a programmable excitation electric field to a target. European Patent Application 94203134.5; EP0709115 A1; 1996.
Ilmoniemi RJ, Virtanen J, Ruohonen J, Karhu J, Aronen HJ, Katila T. Neuronal responses to magnetic stimulation reveal cortical reactivity and connectivity. Neuroreport. 1997;8:3537–40.
Ilmoniemi RJ, Kicic D. Methodology for combined TMS and EEG. Brain Topogr. 2010;22:233–48.
Ilmoniemi RJ, Ruohonen J, Virtanen J. Relationships between magnetic stimulation and MEG/EEG. In: Nilsson J, Panizza M, Grandori F, editors. Advances in occupational medicine and rehabilitation, vol. 2, no. 2. Pavia: Fondazione Salvatore Maugeri Edizioni; 1996. p. 65–72.
Kallioniemi E, Könönen M, Julkunen P. Repeatability of functional anisotropy in navigated transcranial magnetic stimulation—coil-orientation versus response. Neuroreport. 2015;26(9):515–21.
Karhu J, Hannula H, Laine J, Ruohonen J. Navigated transcranial magnetic stimulation: principles and protocol for mapping the motor cortex. In: Rotenberg A, Horvath JC, Pascual-Leone A, editors. Transcranial magnetic stimulation, neuromethods, vol. 89. New York: Springer; 2014. p. 337–59.
Koponen LM, Nieminen JO, Ilmoniemi RJ. Minimum-energy coils for transcranial magnetic stimulation: application to focal stimulation. Brain Stimul. 2015;8:124–34.
Krieg SM, Shiban E, Buchmann N, Gempt J, Foerschler A, Meyer B, Ringel F. Utility of presurgical navigated transcranial magnetic brain stimulation for the resection of tumors in eloquent motor areas. J Neurosurg. 2012;116:994–1001.
Krieg SM, Shiban E, Buchmann N, Meyer B, Ringel F. Presurgical navigated transcranial magnetic brain stimulation for recurrent gliomas in motor eloquent areas. Clin Neurophysiol. 2013;124:522–7.
Krings T, Chiappa KH, Foltys H, Reinges MHT, Cosgrove GR, Thron A. Introducing navigated transcranial magnetic stimulation as a refined brain mapping methodology. Neurosurg Rev. 2001;24:171–9.
Lefaucheur JP, André-Obadia N, Antal A, Ayache SS, Baeken C, Benninger DH, Cantello RM, Cincotta M, de Carvalho M, De Ridder D, Devanne H, Di Lazzaro V, Filipovic SR, Hummel FC, Jääskeläinen SK, Kimiskidis VK, Koch G, Langguth B, Nyffeler T, Oliviero A, Padberg F, Poulet E, Rossi S, Rossini PM, Rothwell JC, Schönfeldt-Lecuona C, Siebner HR, Slotema CW, Stagg CJ, Valls-Sole J, Ziemann U, Paulus W, Garcia-Larrea L. Evidence-based guidelines on the therapeutic use of repetitive transcranial magnetic stimulation (rTMS). Clin Neurophysiol. 2014;125:2150–206.
Massimini M, Ferrarelli F, Huber R, Esser SK, Singh H, Tononi G. Breakdown of cortical effective connectivity during sleep. Science. 2005;309:2228–32.
Näsi T, Mäki H, Kotilahti K, Nissilä I, Haapalahti P, Ilmoniemi RJ. Magnetic-stimulation-related physiological artifacts in hemodynamic near-infrared spectroscopy signals. PLoS One. 2011;6(8):e24002.
Nummenmaa A, Stenroos M, Ilmoniemi RJ, Okada YC, Hämäläinen MS, Raij T. Comparison of spherical and realistically shaped boundary element head models for transcranial magnetic stimulation navigation. Clin Neurophysiol. 2013;124:1995–2007.
Opitz A, Windhoff M, Heidemann RM, Turner R, Thielscher A. How the brain tissue shapes the electric field induced by transcranial magnetic stimulation. Neuroimage. 2011;58:849–59.
Picht T. Current and potential utility of transcranial magnetic stimulation in the diagnostics before brain tumor surgery. CNS Oncol. 2014;3:299–310.
Picht T, Mularski S, Kuehn B, Vajkoczy P, Kombos T, Suess O. Navigated transcranial magnetic stimulation for preoperative functional diagnostics in brain tumor surgery. Neurosurgery. 2009;65:ons93–9.
Picht T, Schmidt S, Brandt S, Frey D, Hannula H, Neuvonen T, Karhu J, Vajkoczy P, Suess O. Preoperative functional mapping for rolandic brain tumor surgery: Comparison of navigated transcranial magnetic stimulation to direct cortical stimulation. Neurosurgery. 2011;69(3):581–8. Discussion 588.
Picht T, Krieg SM, Sollmann N, Rösler J, Niraula B, Neuvonen T, Savolainen P, Lioumis P, Mäkelä JP, Deletis V, Meyer B, Vajkoczy P, Ringel F. A comparison of language mapping by preoperative navigated transcranial magnetic stimulation and direct cortical stimulation during awake surgery. Neurosurgery. 2013;72:808–19.
Rothwell JC, Hallett M, Berardelli A, Eisen A, Rossini P, Paulus W. Magnetic stimulation: motor evoked potentials. Electroencephalogr Clin Neurophysiol Suppl. 1999;52:97–103.
Ruohonen J, Ilmoniemi RJ. Basic physics and design of TMS devices and coils. In: Hallett M, Chokroverty S, editors. Magnetic stimulation in clinical neurophysiology. Philadelphia: Butterworth; 2005. p. 17–30.
Ruohonen J, Karhu J. Navigated transcranial magnetic stimulation. Neurophysiol Clin. 2010;40:7–17.
Säisänen L, Pirinen E, Teitti S, Könönen M, Julkunen P, Määttä S, Karhu J. Factors influencing cortical silent period: optimized stimulus location, intensity and muscle contraction. J Neurosci Methods. 2008;169:231–8.
Schmidt S, Cichy RM, Kraft A, Brocke J, Irlbacher K, Brandt SA. An initial transient-state and reliable measures of corticospinal excitability in TMS studies. Clin Neurophysiol. 2009;120:987–93.
Schmidt S, Bathe-Peters R, Fleischmann R, Rönnefarth M, Scholz M, Brandt SA. Nonphysiological factors in navigated TMS studies; Confounding covariates and valid intracortical estimates. Hum Brain Mapp. 2015;36:40–9.
Sollmann N, Goblirsch-Kolb MF, Ille S, Butenschoen VM, Boeckh-Behrens T, Meyer B, Ringel F, Krieg SM. Comparison between electric-field-navigated and line-navigated TMS for cortical motor mapping in patients with brain tumors. Acta Neurochir. 2016;158:2277–89.
Takahashi S, Vajkoczy P, Picht T. Navigated transcranial magnetic stimulation for mapping the motor cortex in patients with rolandic brain tumors. Neurosurg Focus. 2013;34(4):E3.
Tarapore PE, Tate MC, Findlay AM, Honma SM, Mizuiri D, Berger MS, Nagarajan SS. Preoperative multimodal motor mapping: a comparison of magnetoencephalography imaging, navigated transcranial magnetic stimulation, and direct cortical stimulation. J Neurosurg. 2012;117:354–62.
nTMS workshop group. Protocol hand-out, 8th international nTMS symposium. Berlin; 2016.
Ueno S, Tashiro T, Harada K. Localized stimulation of neural tissues in the brain by means of a paired configuration of time-varying magnetic fields. J Appl Phys. 1988;64:5862–4.
Acknowledgments
This work was supported by the Academy of Finland. We thank Dr. Jaakko Nieminen for helpful comments on the manuscript.
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Hannula, H., Ilmoniemi, R.J. (2017). Basic Principles of Navigated TMS. In: M. Krieg, S. (eds) Navigated Transcranial Magnetic Stimulation in Neurosurgery. Springer, Cham. https://doi.org/10.1007/978-3-319-54918-7_1
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DOI: https://doi.org/10.1007/978-3-319-54918-7_1
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