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Integration of navigated brain stimulation data into radiosurgical planning: potential benefits and dangers

  • Clinical Article - Brain Tumors
  • Published:
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Abstract

Background

Radiosurgical treatment of brain lesions near motor or language eloquent areas requires careful planning to achieve the optimal balance between effective dose prescription and preservation of function. Navigated brain stimulation (NBS) is the only non-invasive modality that allows the identification of functionally essential areas by electrical stimulation or inhibition of cortical neurons analogous to the gold-standard of intraoperative electrical mapping.

Objective

To evaluate the feasibility of NBS data integration into the radiosurgical environment, and to analyze the influence of NBS data on the radiosurgical treatment planning for lesions near or within motor or language eloquent areas of the brain.

Methods

Eleven consecutive patients with brain lesions in presumed motor or language eloquent locations eligible for radiosurgical treatment were mapped with NBS. The radiosurgical team prospectively analyzed the data transfer and classified the influence of the functional NBS information on the radiosurgical treatment planning using a standardized questionnaire.

Results

The semi-automatized data transfer to the radiosurgical planning workstation was flawless in all cases. The NBS data influenced the radiosurgical treatment planning procedure as follows: improved risk-benefit balancing in all cases, target contouring in 0 %, dose plan modification in 81.9 %, reduction of radiation dosage in 72.7 % and treatment indication in 63.7 % of the cases.

Conclusions

NBS data integration into radiosurgical treatment planning is feasible. By mapping the spatial relationship between the lesion and functionally essential areas, NBS has the potential to improve radiosurgical planning safety for eloquently located lesions.

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Conflict of interest

The research reported in this article was supported in part by a grant from the Berlin Cancer Society. Dr. Picht has served as a speaker for Nexstim OY, the manufacturer of the device used in this study. Dr. Picht and Dr. Kufeld had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

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Authors and Affiliations

  1. Department of Neurosurgery, Charité University Hospital, Augustenburger Platz 1, 13353, Berlin, Germany

    Thomas Picht, Sarah Schilt, Dietmar Frey & Peter Vajkoczy

  2. Charité CyberKnife Center, Berlin, Germany

    Markus Kufeld

Authors
  1. Thomas Picht
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  2. Sarah Schilt
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  3. Dietmar Frey
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  4. Peter Vajkoczy
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  5. Markus Kufeld
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Corresponding author

Correspondence to Thomas Picht.

Additional information

Thomas Picht and Sarah Schilt contributed equally to this paper.

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Picht, T., Schilt, S., Frey, D. et al. Integration of navigated brain stimulation data into radiosurgical planning: potential benefits and dangers. Acta Neurochir 156, 1125–1133 (2014). https://doi.org/10.1007/s00701-014-2079-8

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  • DOI: https://doi.org/10.1007/s00701-014-2079-8

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