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Function-specific Tractography of Language Pathways Based on nTMS Mapping in Patients with Supratentorial Lesions

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Abstract

Purpose

In patients with supratentorial lesions diffusion tensor imaging fiber tracking (DTI-FT) is increasingly used to visualize subcortical fiber courses. Navigated transcranial magnetic stimulation (nTMS) was applied in this study to reveal specific cortical functions by investigating the particular language errors elicited by stimulation. To make DTI-FT more function-specific, the identified language-positive nTMS spots were used as regions of interest (ROIs).

Methods

In this study 40 patients (mean age 53.8 ± 16.0 years) harboring language-eloquent left hemispheric lesions underwent preoperative nTMS language mapping. All induced error categories were separately defined as a ROI and used for function-specific nTMS-based DTI-FT. The fractions of patients showing various subcortical language-related pathways and the fibers-per-tract ratio (number of visualized fibers divided by the number of visualized tracts) were evaluated and compared for tractography with the single error types against less specific tractography including all identified cortical language sites (all errors except hesitations).

Results

The nTMS-based DTI-FT using all errors except hesitations led to high fractions of visualized tracts (81.1% of patients), with a fibers-per-tract ratio of 538.4 ± 340.5. When only using performance errors, a predominant visualization of the superior longitudinal fascicle (SLF) occurred, which is known to be involved in articulatory processes. Fibers-per-tract ratios were comparatively stable for all single error categories when compared to all errors except hesitations (p > 0.05).

Conclusion

This is one of the first studies aiming on function-specific tractography. The results demonstrated that when using different error categories as ROIs, more detailed nTMS-based DTI-FT and, therefore, potentially superior intraoperative guidance becomes possible.

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Abbreviations

3D:

Three-dimensional

AAT:

Aachen Aphasia Test

AF:

Arcuate fascicle

ArF:

Arcuate fibers

AVM:

Arteriovenous malformation

BMRC:

British Medical Research Council

CF:

Commissural fibers

CNT:

Corticonuclear tract

CtF:

Corticothalamic fibers

DES:

Direct electrical stimulation

DTI:

Diffusion tensor imaging

DTI-FT:

Diffusion tensor imaging fiber tracking

FA:

Fractional anisotropy

FAT:

Fractional anisotropy threshold

FL:

Fiber length

FLAIR:

Fluid attenuated inversion recovery

fMRI:

Functional magnetic resonance imaging

FoF:

Fronto-occipital fascicle

ILF:

Inferior longitudinal fascicle

KPS:

Karnofsky performance status

MRI:

Magnetic resonance imaging

nTMS:

Navigated transcranial magnetic stimulation

rMT:

Resting motor threshold

ROI:

Region of interest

SD:

Standard deviation

SLF:

Superior longitudinal fascicle

UC:

Uncinate fascicle

WHO:

World Health Organization

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Funding

The study was completely financed by institutional grants from the Department of Neurosurgery and the Department of Neuroradiology.

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Authors and Affiliations

  1. Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany

    Nico Sollmann & Kornelia Kreiser

  2. Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany

    Nico Sollmann, Haosu Zhang, Severin Schramm, Sebastian Ille, Chiara Negwer, Bernhard Meyer & Sandro M. Krieg

  3. TUM-Neuroimaging Center, Klinikum rechts der Isar, Technische Universität München, Munich, Germany

    Nico Sollmann, Sebastian Ille & Sandro M. Krieg

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  1. Nico Sollmann
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Corresponding author

Correspondence to Sandro M. Krieg.

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Conflict of interest

N. Sollmann received fees from Nexstim Plc (Helsinki, Finland). S.M. Krieg is consultant for Nexstim Plc (Helsinki, Finland) and received fees from Medtronic (Meerbusch, Germany) and Carl Zeiss Meditec (Oberkochen, Germany). S.M. Krieg and B. Meyer received research grants and are consultants for Brainlab AG (Munich, Germany). B. Meyer received fees, consulting fees, and research grants from Medtronic (Meerbusch, Germany), Icotec ag (Altstätten, Switzerland), and Relievant Medsystems (Sunnyvale, CA, USA), fees and research grants from Ulrich Medical (Ulm, Germany), fees and consulting fees from Spineart Deutschland GmbH (Frankfurt, Germany) and DePuy Synthes (West Chester, PA, USA), and royalties from Spineart Deutschland GmbH (Frankfurt, Germany). N. Sollmann, H. Zhang, S. Schramm, S. Ille, C. Negwer, K. Kreiser, B. Meyer and S.M. Krieg declare that they have no conflict of interest regarding the materials used or the results presented in this study.

Ethical standards

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.

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Nico Sollmann and Haosu Zhang contributed equally to the manuscript.

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Sollmann, N., Zhang, H., Schramm, S. et al. Function-specific Tractography of Language Pathways Based on nTMS Mapping in Patients with Supratentorial Lesions. Clin Neuroradiol 30, 123–135 (2020). https://doi.org/10.1007/s00062-018-0749-2

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