Navigated Transcranial Magnetic Stimulation for Presurgical Planning

Abstract

Purpose: This paper describes the potential of navigated transcranial magnetic stimulation to map the motor cortex in patients with mass lesions near the primary motor cortex by comparing the results of this technique to those of functional MRI. Material and Methods: Ten patients with mass lesions near the central sulcus were studied preoperatively using a figure-of-eight transcranial magnetic stimulator attached to a neuronavigation system to allow for direct visualization of the stimulated brain region. Subsequently, in all patients a blood oxygenation level dependent 2D multislice multishot T₂*-weighted gradient echo EPI sequence on a 1.5 T Philips Gyroscan during motor activation was performed. Results of both methods were coregistered and compared. Results: The distances between the peak parenchymal fMRI activation and the cortical area where TMS elicited the maximum MEPs ranged between 0 and 1.2 cm (mean 0.6 cm, SD 0.4 cm). Conclusion: We conclude that navigated TMS is a reliable alternative for localizing the motor-related areas in the human brain preoperatively and therefore may be a useful adjunct or, in selected patients, even a helpful alternative to functional MRI.

Functional Magnetic Resonance Imaging - Motor Cortex - Presurgical Planning - Transcranial Magnetic Stimulation

References

• 1 Gallen C C, Sobel D F, Lewine J D, Sanders J A, Hart B L, Davis L E, Orrison W W. Neuromagnetic mapping of brain function.  Radiology. 1993;  187 863-867
• 2 Buchner H, Adams L, Knepper A, Ruger R, Laborde G, Gilsbach J M, Ludwig I, Reul J, Scherg M. Preoperative localisation of the central sulcus by dipole source analysis of early somatosensory evoked potentials and three-dimensional magnetic resonance imaging.  J Neurosurg. 1994;  80 849-856
• 3 Leblanc R, Meyer E, Bub D, Zatorre R J, Evans A C. Language localisation with activation positron emisson tomography scanning.  Neurosurgery. 1992;  31 369-373
• 4 Krings T, Reul J, Spetzger U, Klusmann A, Roessler F, Gilsbach J M, Thron A. Functional magnetic resonance mapping of sensory motor cortex for image-guided neurosurgical intervention.  Acta Neurochirurgica. 1998;  140 215-222
• 5 Kwong K K. Functional MRI with echo planar imaging.  Magn Reson Q. 1995;  11 1-20
• 6 Krings T, Erberich S, Roessler F, Reul J, Thron A. MR BOLD signal differences in parenchymal and large draining vessels. Implications for functional MR Imaging.  Am J Neurorad AJNR. 1999;  20 1907-1914
• 7 Friston K J, Ashburner J, Frith C D, Poline J B, Heather J D, Frackowiak R SJ. Spatial registration and normalisation of images.  Human Brain Mapping. 1995;  3 165-189
• 8 Kwong K K, Bellieveau J W, Chesler D A, Goldberg I E, Weisskoff R M, Poncelet B P, Kennedy D N, Hoppel B E, Cohen M S, Turner R, Cheng H M, Brady T J, Rosen B R. Dynamic magnetic resonance imaging of human brain activity during primary sensory stimulation.  Proc Natl Acad Sci USA. 1992;  89 5675-5679
• 9 Brasil-Neto J P, Cohen L G, Panizza M, Nilsson J, Roth B J, Hallett M. Optimal focal transcranial magnetic activation of the human motor cortex: effects of coil orientation, shape of the induced current pulse, and stimulus intensity.  J Clin Neurophys. 1992;  9 132-136
• 10 Krings T, Naujokat C, Graf v. Keyserlingk D. Representation of cortical motor function as revealed by stereotactic transcranial magnetic stimulation.  Electroenceph Clin Neurophysiol. 1998;  109 85-93
• 11 Krings T, Buchbinder B R, Butler W E, Chiappa K H, Jiang H J, Rosen B R, Cosgrove G R. Stereotactic transcranial magnetic stimulation: Correlation with direct electrical cortical stimulation.  Neurosurgery. 1997;  41 1319-1325
• 12 Yousry T A, Schmid U D, Alkahdi H, Schmidt D, Peraud A, Buettner A, Winkler P. Localisation of the motor hand area to a knob on the precentral gyrus. A new landmark.  Brain. 1997;  120 141-157
• 13 Day B L, Rothwell J C, Thompson P D, Dick J PR, Cowan J MA, Berardelli A, Marsden C A. Motor cortex stimulation in intact man. 2. Multiple descending volleys.  Brain. 1987;  110 1191-1201
• 14 Henneman E. Relation between size of neurons and their susceptibility to discharge.  Science. 1957;  26 1345-1347
• 15 Kiers L, Clouston P, Chiappa K H, Cros D. Assessment of cortical motor output: Compound muscle action potential versus twitch force recording.  Electroenceph clinl Neurophysiol. 1995;  97 131-139
• 16 Levy W J, Amassian V E, Schmid U D, Jungreis C. Mapping of motor cortex gyral sites non-invasively by transcranial magnetic stimulation in normal subjects and patients. Magnetic Motor Stimulation: Basic Principles and Clinical Experience EEG.  Suppl. 1991;  43 51-75
• 17 Cohen L G, Bandinelli S, Topka H R, Fuhr P, Roth B J, Hallett M. Topographic maps of human motor cortex in normal and pathological conditions: Mirror movements, amputations and spinal cord injuries. Magnetic Motor Stimulation: Basic Principles and Clinical Experience EEG.  Suppl. 1991;  43 36-50
• 18 Verhagen Metman L, Bellevich J S, Jones S M, Barber M D, Streletz L J. Topographic mapping of human motor cortex with transcranial magnetic stimulation: Homunculus revisited.  Brain Topography. 1993;  6 13-19
• 19 Wassermann E M, McShane L M, Hallett M, Cohen L G. Noninvasive mapping of muscle representations in human motor cortex.  Electroenceph Clin Neurophysiol. 1992;  85 1-8
• 20 Brasil-Neto J P, McShane L M, Fhr P, Hallett M, Cohen L G. Topographic mapping of the human motor cortex with magnetic stimulation: Factors affecting accuracy and reproducibility.  Electroenceph Clin Neurophysiol. 1992;  85 9-16
• 21 Spetzger U, Laborde G, Gilsbach J M. Frameless neuronavigation in modern neurosurgery.  Minim Invas Neurosurg. 1995;  38 163-166
• 22 Fox P T, Raichle M E. Focal physiological uncoupling of cerebral blood flow and oxidative metabolism during somatosensory stimulation in human subjects.  Proc Natl Acad Sci USA. 1986;  83 1140-1144
• 23 Krings T, Buchbinder B R, Butler W E, Chiappa K H, Jiang H J, Cosgrove G R, Rosen B R. Functional magnetic resonance imaging and transcranial magnetic stimulation: Complementary approaches in the evaluation of cortical motor function.  Neurology. 1997;  48 1406-1416
• 24 Weisskoff R M. Functional MRI: Are we all moving towards artifactual conclusions? Or fMRI fact or fancy?.  NMR Biomed. 1995;  8 101-103
• 25 Hajnal J, Myers R, Oatridge A, Schwieso J, Young I, Bydder G. Artifacts due to stimulus correlated motion in functional imaging of the brain.  Magn Reson Med. 1994;  31 283-291