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Motor cortex evaluation by nTMS after surgery of central region tumors: a feasibility study

  • Clinical Article
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Abstract

Background

Largely discussed during the past decade, motor cortex reorganization in brain tumor surgery has been investigated only by few studies. We therefore aimed to investigate cortical motor representation after resection of perirolandic WHO grade II and III gliomas using navigated transcranial magnetic stimulation (nTMS).

Methods

Five patients were examined before neurosurgery and after a follow-up period of 17.7 ± 6.8 months. As a control, five healthy age-matched subjects were equally studied by nTMS in two sessions spaced 12.6 (range 2–35) days apart. Resting motor thresholds (RMT), hotspots and centers of gravity (CoG) were identified for the first dorsal interosseous (FDI), abductor pollicis brevis (APB), extensor digitorum (EXT), tibialis anterior (TA) and abductor hallucis (AH) muscles. Euclidian distances, coefficients of variance and intraclass correlation coefficients (ICC) were calculated.

Results

Healthy subjects showed moderate to excellent reliability measurement of RMT (ICC = 0.69–0.94). Average displacement of CoGs across sessions was 0.68 ± 0.34 cm in the dominant and 0.76 ± 0.38 cm in the non-dominant hemisphere; hotspots moved 0.87 ± 0.51 cm and 0.83 ± 0.45 cm, respectively.

In one patient these parameters differed significantly from the control group (p < 0.05 for both CoGs and hotspots). Overall, all patients’ CoGs moved 1.12 ± 0.93 cm, and hotspots were 1.06 ± 0.7 cm apart. In both patients and healthy subjects, movement of assessed parameters was more important along the X- than the Y-axis.

Conclusions

nTMS allows evaluating cortical reorganization after brain tumor surgery. It may contribute to the understanding of neurofunctional dynamics, thus influencing therapeutic strategy.

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Acknowledgement

The authors thank Marina Heibel for her assistance with figure preparation.

Disclosure

Dr. Forster and Dr. Szelényi have served as speakers for Nexstim. Financing of the study was completely provided by institutional grants from the Department of Neurosurgery. The authors have no personal or institutional interest in any of the devices, materials or methods described in this article.

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None.

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Authors and Affiliations

  1. Department of Neurosurgery, Goethe University Hospital, Schleusenweg 2-16, 60528, Frankfurt am Main, Germany

    Marie-Thérèse Forster, Christian Senft, Volker Seifert & Andrea Szelényi

  2. Department of Neuroradiology, Goethe University Hospital, Schleusenweg 2-16, 60528, Frankfurt am Main, Germany

    Elke Hattingen & Mario Lorei

Authors
  1. Marie-Thérèse Forster
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  2. Christian Senft
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  3. Elke Hattingen
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  6. Andrea Szelényi
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Correspondence to Marie-Thérèse Forster.

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Forster, MT., Senft, C., Hattingen, E. et al. Motor cortex evaluation by nTMS after surgery of central region tumors: a feasibility study. Acta Neurochir 154, 1351–1359 (2012). https://doi.org/10.1007/s00701-012-1403-4

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  • DOI: https://doi.org/10.1007/s00701-012-1403-4

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