Risk Stratification by nTMS via Corticospinal Excitability in Motor Cortex-Related Surgery

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Abstract

Brain tumors within or close to motor areas impair not only the motor cortex but also subcortical pathways. Such impairment can be subclinical but nonetheless increases the risk of surgery-related neurological deficits.

Many methods of functional brain mapping are able to demonstrate the topographical relationship between tumor and cortex; nTMS, however, can also assess the functional status of the motor system in brain tumor patients by measuring corticospinal excitability (CSE).

This chapter reviews data on various parameters of motor-evoked potentials for CSE and how these parameters might enable us to estimate the integrity of the motor system: recruitment curve, cortical silent period, and resting motor threshold (rMT). Moreover, the rMT ratio between tumor and healthy hemispheres is presented as a tool for preoperative risk stratification in motor cortex-related surgery. Such nTMS-based neurophysiological data can impact on balancing risks and benefits prior to surgery, counseling patients, planning surgeries, and—as a consequence—on the patients’ outcome, survival, and quality of life.

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Copyright information

© Springer International Publishing AG 2017

Authors and Affiliations

  1. 1.Department of NeurosurgeryCharité—Universitaetsmedizin Berlin, Campus Charité MitteBerlinGermany

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