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

  • Nico Sollmann
  • Haosu Zhang
  • Severin Schramm
  • Sebastian Ille
  • Chiara Negwer
  • Kornelia Kreiser
  • Bernhard Meyer
  • Sandro M. KriegEmail author
Original Article



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).


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).


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).


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.


Diffusion tensor imaging Fiber tracking Glioma Navigated transcranial magnetic stimulation Preoperative imaging 





Aachen Aphasia Test


Arcuate fascicle


Arcuate fibers


Arteriovenous malformation


British Medical Research Council


Commissural fibers


Corticonuclear tract


Corticothalamic fibers


Direct electrical stimulation


Diffusion tensor imaging


Diffusion tensor imaging fiber tracking


Fractional anisotropy


Fractional anisotropy threshold


Fiber length


Fluid attenuated inversion recovery


Functional magnetic resonance imaging


Fronto-occipital fascicle


Inferior longitudinal fascicle


Karnofsky performance status


Magnetic resonance imaging


Navigated transcranial magnetic stimulation


Resting motor threshold


Region of interest


Standard deviation


Superior longitudinal fascicle


Uncinate fascicle


World Health Organization



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

Compliance with ethical guidelines

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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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Nico Sollmann
    • 1
    • 2
    • 3
  • Haosu Zhang
    • 2
  • Severin Schramm
    • 2
  • Sebastian Ille
    • 2
    • 3
  • Chiara Negwer
    • 2
  • Kornelia Kreiser
    • 1
  • Bernhard Meyer
    • 2
  • Sandro M. Krieg
    • 2
    • 3
    Email author
  1. 1.Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der IsarTechnische Universität MünchenMunichGermany
  2. 2.Department of Neurosurgery, Klinikum rechts der IsarTechnische Universität MünchenMunichGermany
  3. 3.TUM-Neuroimaging Center, Klinikum rechts der IsarTechnische Universität MünchenMunichGermany

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