ReviewActa neurochirurgica2024
Preoperative nTMS analysis: a sensitive tool to detect imminent motor deficits in brain tumor patients.
Review in Acta neurochirurgica, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.
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Who cites it
4 citing papers in PubMed.
- Role of patient frailty in resection of newly diagnosed motor eloquent glioblastomas guided by a navigated transcranial magnetic stimulation and tractography approach.Journal of neuro-oncology · 2025Article
- Resting motor threshold in navigated transcranial magnetic stimulation: relationship between inter-individual variance and distinct clinical and anatomical factors.Acta neurochirurgica · 2025Article
- Analysis of Neuronal Excitability Profiles for Motor-Eloquent Brain Tumor Entities Using nTMS in 800 Patients.Cancers · 2025Article
- Transcranial Magnetic Stimulation-Electroencephalography (TMS-EEG) in Neurosurgery: Unexplored Path Towards Personalized Brain Surgery.Journal of personalized medicine · 2024Review
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Authors and funding
12 authors.
Funding
Abstract
backgroundOne of the challenges in surgery of tumors in motor eloquent areas is the individual risk assessment for postoperative motor disorder. Previously a regression model was developed that permits estimation of the risk prior to surgery based on topographical and neurophysiological data derived from investigation with nTMS (navigated Transcranial Magnetic Stimulation). This study aims to analyze the impact of including additional neurophysiological TMS parameters into the established risk stratification model for motor outcome after brain tumor surgery.
methodsBiometric and clinical data of 170 patients with glioma in motor eloquent areas were collected prospectively. In addition, the following nTMS parameters were collected bihemispherically prior to surgery: resting motor threshold (RMT), recruitment curve (RC), cortical silent period (CSP) and a nTMS based fibertracking to measure the tumor tract distance (TTD). Motor function was quantified by Medical Research Council Scale (MRCS) preoperatively, seven days and three months postoperatively. Association between nTMS parameters and postoperative motor outcome was investigated in bivariate and multivariable analyses.
resultsThe bivariate analysis confirmed the association of RMT ratio with the postoperative motor outcome after seven days with higher rates of worsening in patients with RMT ratio > 1.1 compared to patients with RMT ratio ≤ 1.1 (31.6% vs. 15.1%, p = 0.009). Similarly, an association between a pathological CSP ratio and a higher risk of new postoperative motor deficits after seven days was observed (35.3% vs. 16.7% worsening, p = 0.025). A pathological RC Ratio was associated postoperative deterioration of motor function after three months (42.9% vs. 16.2% worsening, p = 0.004). In multiple regression analysis, none of these associations were statistically robust.
conclusionsThe current results suggest that the RC ratio, CSP ratio and RMT ratio individually are sensitive markers associated with the motor outcome 7 days and 3 months after tumor resection in a presumed motor eloquent location. They can therefore supply valuable information during preoperative risk-benefit-balancing. However, underlying neurophysiological mechanisms might be too similar to make the parameters meaningful in a combined model.
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