Skip to main content

nTMS Motor Mapping: Basic Principles and Clinical Use

  • Chapter
  • First Online:
Navigated Transcranial Magnetic Stimulation in Neurosurgery

Abstract

The goal of glioma surgery is maximal safe resection. These intrinsic brain neoplasms, however, lack a clear margin and frequently infiltrate eloquent areas of the brain, thus making their surgical resection challenging. Therefore, preoperative investigations like nTMS that aid in anatomico-functional tumor characterization help to define the extent of the tumor and to determine the feasibility of complete resection, which is helpful to the surgeon. Coupled with intraoperative adjuncts like navigated cortical and subcortical mapping and monitoring techniques, preoperative nTMS maps can help to identify a tumor-infiltrated functional cortex during surgery to maximize the extent of resection. Combined use of these different modalities before and during surgery is encouraged to meet surgical goals and ensure best patient outcomes.

In this chapter, we discuss the role of nTMS in motor mapping for tumors in the perirolandic region.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 109.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 159.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Similar content being viewed by others

References

  • Coburger J, Merkel A, Scherer M, et al. Low-grade glioma surgery in intraoperative magnetic resonance imaging: results of a multicenter retrospective assessment of the German Study Group for intraoperative magnetic resonance imaging. Neurosurgery. 2016;78:775–86.

    Article  PubMed  Google Scholar 

  • Conway N, Wildschuetz N, Moser T, Bulubas L, Sollmann N, Tanigawa N, Meyer B, Krieg SM. Cortical plasticity of motor-eloquent areas measured by navigated transcranial magnetic stimulation in patients with glioma. J Neurosurg. 2017;20:1–11.

    Article  Google Scholar 

  • De Witt Hamer PC, Robles SG, Zwinderman AH, Duffau H, Berger MS. Impact of intraoperative stimulation brain mapping on glioma surgery outcome: a meta-analysis. J Clin Oncol. 2012;30:2559–65.

    Article  PubMed  Google Scholar 

  • Fisicaro RA, Jiao RX, Stathopoulos C, Petrovich Brennan NM, Peck KK, Holodny AI. Challenges in identifying the foot motor region in patients with brain tumor on routine MRI: advantages of fMRI. AJNR. 2015;36(8):1488–93.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • 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]

    Article  PubMed  Google Scholar 

  • Frey D, Schilt S, Strack V, Zdunczyk A, Rösler J, Niraula B, Vajkoczy P, Picht T. Navigated transcranial magnetic stimulation improves the treatment outcome in patients with brain tumors in motor eloquent locations. Neuro Oncol. 2014;16:1365–72.

    Article  PubMed  PubMed Central  Google Scholar 

  • Jakola AS, Myrmel KS, Kloster R, Torp SH, Lindal S, UnsgÃ¥rd G, Solheim O. Comparison of a strategy favoring early surgical resection vs a strategy favoring watchful waiting in low grade gliomas. JAMA. 2012;308:1881–8.

    Article  CAS  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • Krieg SM, Sabih J, Bulubasova L, Obermueller T, Negwer C, Janssen I, Shiban E, Meyer B, Ringel F. Preoperative motor mapping by navigated transcranial magnetic brain stimulation improves outcome for motor eloquent lesions. Neuro Oncol. 2014;16:1274–82.

    Article  PubMed  PubMed Central  Google Scholar 

  • Lacroix M, Abi-Said D, Fourney DR, et al. A multivariate analysis of 416 patients with glioblastoma multiforme: prognosis, extent of resection, and survival. J Neurosurg. 2001;95:190–8.

    Article  CAS  PubMed  Google Scholar 

  • Li YM, Suki D, Hess K, Sawaya R. The influence of maximum safe resection of glioblastoma on survival in 1229 patients: can we do better than gross-total resection? J Neurosurg. 2016;124:977–88.

    Article  PubMed  Google Scholar 

  • McGirt MJ, Mukherjee D, Chaichana KL, Than KD, Weingart JD, Quinones-Hinojosa A. Association of surgically acquired motor and language deficits on overall survival after resection of glioblastoma multiforme. Neurosurgery. 2009;65:463–9.

    Article  PubMed  Google Scholar 

  • Paiva WS, Fonoff ET, Marcolin MA, Cabrera HN, Teixeira MJ. Cortical mapping with navigated transcranial magnetic stimulation in low-grade glioma surgery. Neuropsychiatr Dis Treat. 2012;8:197–201.

    Article  PubMed  PubMed Central  Google Scholar 

  • 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(6 Suppl):93–8. [discussion 98–9]

    PubMed  Google Scholar 

  • Picht P, Schmidt S, Brandt S, Frey D, Hannula H, Neuvonen T, et al. Preoperative functional mapping for rolandic brain tumor surgery: comparison of navigated transcranial magnetic stimulation to direct cortical stimulation. Neurosurgery. 2011;69:581–8. discussion 588]

    Article  PubMed  Google Scholar 

  • Picht T, Schulz J, Hanna M, Schmidt S, Suess O, Vajkoczy P. Assessment of the influence of navigated transcranial magnetic stimulation on surgical planning for tumors in or near the motor cortex. Neurosurgery. 2012;70:1248–56. [discussion 1256–7]

    Article  PubMed  Google Scholar 

  • Picht T, Schulz J, Vajkoczy P. The preoperative use of navigated transcranial magnetic stimulation facilitates early resection of suspected low-grade gliomas in the motor cortex. Acta Neurochir. 2013;155:1813–21.

    Article  PubMed  Google Scholar 

  • Picht T, Frey D, Thieme S, Kliesch S, Vajkoczy P. Presurgical navigated TMS motor cortex mapping improves outcome in glioblastoma surgery: a controlled observational study. J Neurooncol. 2016;126:535–43.

    Article  PubMed  Google Scholar 

  • Prabhu SS, Gasco J, Tummala S, Weinberg JS, Rao G. Intraoperative magnetic resonance imaging-guided tractography with integrated monopolar subcortical functional mapping for resection of brain tumors. Clinical article. J Neurosurg. 2011;114(3):719–26.

    Article  PubMed  Google Scholar 

  • Rizzo V, Terranova C, Conti A, Germanò A, Alafaci C, Raffa G, et al. Preoperative functional mapping for rolandic brain tumor surgery. Neurosci Lett. 2014;583:136–41.

    Article  CAS  PubMed  Google Scholar 

  • Sanai N, Polley M-Y, McDermott MW, Parsa AT, Berger MS. An extent of resection threshold for newly diagnosed glioblastomas. J Neurosurg. 2011;115:3–8.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  PubMed Central  Google Scholar 

  • Tarapore PE, Picht T, Bulubas L, Shin Y, Kulchytska N, Meyer B, Berger MS, Nagarajan SS, Krieg SM. Safety and tolerability of navigated TMS for preoperative mapping in neurosurgical patients. Clin Neurophysiol. 2016;127:1895–900.

    Article  PubMed  Google Scholar 

  • Wu J-S, Zhou L-F, Tang W-J, Mao Y, Hu J, Song Y-Y, Hong X-N, Du G-H. Clinical evaluation and follow-up outcome of diffusion tensor imaging-based functional neuronavigation: a prospective, controlled study in patients with gliomas involving pyramidal tracts. Neurosurgery. 2007;61:935–48.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Sujit S. Prabhu M.D., F.R.C.S. (Ed), F.A.A.N.S. .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2017 Springer International Publishing AG

About this chapter

Cite this chapter

Bastos, D., Prabhu, S.S. (2017). nTMS Motor Mapping: Basic Principles and Clinical Use. In: M. Krieg, S. (eds) Navigated Transcranial Magnetic Stimulation in Neurosurgery. Springer, Cham. https://doi.org/10.1007/978-3-319-54918-7_5

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-54918-7_5

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-54917-0

  • Online ISBN: 978-3-319-54918-7

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics