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Protocol for motor and language mapping by navigated TMS in patients and healthy volunteers; workshop report

  • Review Article - Neurosurgical Techniques
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Abstract

Introduction

Navigated transcranial magnetic stimulation (nTMS) is increasingly used for preoperative mapping of motor function, and clinical evidence for its benefit for brain tumor patients is accumulating. In respect to language mapping with repetitive nTMS, literature reports have yielded variable results, and it is currently not routinely performed for presurgical language localization. The aim of this project is to define a common protocol for nTMS motor and language mapping to standardize its neurosurgical application and increase its clinical value.

Methods

The nTMS workshop group, consisting of highly experienced nTMS users with experience of more than 1500 preoperative nTMS examinations, met in Helsinki in January 2016 for thorough discussions of current evidence and personal experiences with the goal to recommend a standardized protocol for neurosurgical applications.

Results

nTMS motor mapping is a reliable and clinically validated tool to identify functional areas belonging to both normal and lesioned primary motor cortex. In contrast, this is less clear for language-eloquent cortical areas identified by nTMS. The user group agreed on a core protocol, which enables comparison of results between centers and has an excellent safety profile. Recommendations for nTMS motor and language mapping protocols and their optimal clinical integration are presented here.

Conclusion

At present, the expert panel recommends nTMS motor mapping in routine neurosurgical practice, as it has a sufficient level of evidence supporting its reliability. The panel recommends that nTMS language mapping be used in the framework of clinical studies to continue refinement of its protocol and increase reliability.

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Author information

Author notes

  1. All authors contributed equally to this work

Authors and Affiliations

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

    Sandro M. Krieg

  2. BioMag Laboratory, HUS Medical Imaging Center, University of Helsinki and Helsinki University Hospital, P.O. Box 340, HUS, 00029, Helsinki, Finland

    Pantelis Lioumis, Jyrki P. Mäkelä & Anne-Mari Vitikainen

  3. Department of Clinical Neurophysiology, HUS Medical Imaging Center, University of Helsinki and Helsinki University Hospital, P.O. Box 340, HUS, 00029, Helsinki, Finland

    Juha Wilenius & Selja Vaalto

  4. Nexstim Plc, Elimäenkatu 9 B, 00510, Helsinki, Finland

    Jari Karhu, Henri Hannula & Petri Savolainen

  5. Department of Biomedical Engineering and Computational Science, Aalto University, Espoo, Finland

    Henri Hannula

  6. Center of Neurosurgery, University Hospital Cologne, Kerpener Str. 62, 50937, Cologne, Germany

    Carolin Weiss Lucas

  7. Department of Neurosurgery Inselspital, Bern University Hospital University of Berne, 3010, Berne, Switzerland

    Kathleen Seidel

  8. Department of Neurosurgery, Helsinki University Hospital and Clinical Neurosciences, Neurosurgery, University of Helsinki, P.O. Box 266, Topeliuksenkatu 5, 00260, Helsinki, Finland

    Aki Laakso

  9. Department of Clinical Neurophysiology (R2:01), Karolinska University Hospital, 17176, Solna, Stockholm, Sweden

    Mominul Islam

  10. Epilepsy Unit, Department of Pediatric Neurology, Helsinki University Central Hospital, Lastenlinnantie 2 PL 280, HUS, 00029, Helsinki, Finland

    Henri Lehtinen

  11. Department of Neurological Surgery, University of California, 505 Parnassus Ave, Moffitt, San Francisco, CA, 94143, USA

    Phiroz E. Tarapore

  12. Department of Neurosurgery, Charité–Universitätsmedizin Berlin, Campus Benjamin Franklin, Augustenburger Platz 1, 13353, Berlin, Germany

    Thomas Picht

Authors
  1. Sandro M. Krieg
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  2. Pantelis Lioumis
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  3. Jyrki P. Mäkelä
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  4. Juha Wilenius
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  5. Jari Karhu
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  6. Henri Hannula
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  7. Petri Savolainen
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  8. Carolin Weiss Lucas
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  9. Kathleen Seidel
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  10. Aki Laakso
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  11. Mominul Islam
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  12. Selja Vaalto
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  13. Henri Lehtinen
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  14. Anne-Mari Vitikainen
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  15. Phiroz E. Tarapore
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  16. Thomas Picht
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Corresponding author

Correspondence to Sandro M. Krieg.

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Funding

Nexstim Plc. (Helsinki, Finland) provided financial support in the form of travel funding to the venue site at BioMag Laboratory, HUS Medical Imaging Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland. The sponsor had no role in the design or conduct of this report.

Conflicts of interest

SK and TP are consultants for Brainlab AG (Munich, Germany) and for Nexstim Plc. (Helsinki, Finland). PL is consultant for Nexstim Plc. HH, PS, and JK are employed by Nexstim Plc. Yet, all authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

Ethical approval

Since this is a report from an expert panel, no ethics approval was obtained. This article does not contain any studies with human participants performed by any of the authors.

Additional information

The navigated TMS workshop group; Helsinki Meeting 2016

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Krieg, S.M., Lioumis, P., Mäkelä, J.P. et al. Protocol for motor and language mapping by navigated TMS in patients and healthy volunteers; workshop report. Acta Neurochir 159, 1187–1195 (2017). https://doi.org/10.1007/s00701-017-3187-z

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  • DOI: https://doi.org/10.1007/s00701-017-3187-z

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