Preoperative individual-target transcranial magnetic stimulation demonstrates an effect comparable to intraoperative direct electrical stimulation in language-eloquent glioma mapping and improves postsurgical outcome: A retrospective fiber-tracking and electromagnetic simulation study
BackgroundEfforts to resection of glioma lesions located in brain-eloquent areas must balance the extent of resection (EOR) and functional preservation. Currently, intraoperative direct electrical stimulation (DES) is the gold standard for achieving the maximum EOR while preserving as much functiona...
| Main Authors: | , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2023-02-01
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| Series: | Frontiers in Oncology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fonc.2023.1089787/full |
| _version_ | 1811173220284366848 |
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| author | Sanzhong Li Yunfeng Mu Yang Rao Chuanzhu Sun Xiang Li Xiang Li Huan Liu Xun Yu Xiao Yan Yunxia Ding Yangtao Wang Zhou Fei |
| author_facet | Sanzhong Li Yunfeng Mu Yang Rao Chuanzhu Sun Xiang Li Xiang Li Huan Liu Xun Yu Xiao Yan Yunxia Ding Yangtao Wang Zhou Fei |
| author_sort | Sanzhong Li |
| collection | DOAJ |
| description | BackgroundEfforts to resection of glioma lesions located in brain-eloquent areas must balance the extent of resection (EOR) and functional preservation. Currently, intraoperative direct electrical stimulation (DES) is the gold standard for achieving the maximum EOR while preserving as much functionality as possible. However, intraoperative DES inevitably involves risks of infection and epilepsy. The aim of this study was to verify the reliability of individual-target transcranial magnetic stimulation (IT-TMS) in preoperative mapping relative to DES and evaluate its effectiveness based on postsurgical outcomes.MethodsSixteen language-eloquent glioma patients were enrolled. Nine of them underwent preoperative nTMS mapping (n=9, nTMS group), and the other seven were assigned to the non-nTMS group and did not undergo preoperative nTMS mapping (n=7). Before surgery, online IT-TMS was performed during a language task in the nTMS group. Sites in the cortex at which this task was disturbed in three consecutive trials were recorded and regarded as positive and designated nTMS hotspots (HSnTMS). Both groups then underwent awake surgery and intraoperative DES mapping. DES hotspots (HSDES) were also determined in a manner analogous to HSnTMS. The spatial distribution of HSnTMS and HSDES in the nTMS group was recorded, registered in a single brain template, and compared. The center of gravity (CoG) of HSnTMS (HSnTMS-CoG)-based and HSDES-CoG-based diffusion tensor imaging-fiber tracking (DTI-FT) was performed. The electromagnetic simulation was conducted, and the values were then compared between the nTMS and DES groups, as were the Western Aphasia Battery (WAB) scale and fiber-tracking values.ResultsHSnTMS and HSDES showed similar distributions (mean distance 6.32 ± 2.6 mm, distance range 2.2-9.3 mm, 95% CI 3.9-8.7 mm). A higher fractional anisotropy (FA) value in nTMS mapping (P=0.0373) and an analogous fiber tract length (P=0.2290) were observed. A similar distribution of the electric field within the brain tissues induced by nTMS and DES was noted. Compared with the non-nTMS group, the integration of nTMS led to a significant improvement in language performance (WAB scores averaging 78.4 in the nTMS group compared with 59.5 in the non-nTMS group, P=0.0321 < 0.05) as well as in brain-structure preservation (FA value, P=0.0156; tract length, P=0.0166).ConclusionPreoperative IT-TMS provides data equally crucial to DES and thus facilitates precise brain mapping and the preservation of linguistic function. |
| first_indexed | 2024-04-10T17:44:18Z |
| format | Article |
| id | doaj.art-787fecc5805748b28ebb5778da895c77 |
| institution | Directory Open Access Journal |
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| language | English |
| last_indexed | 2024-04-10T17:44:18Z |
| publishDate | 2023-02-01 |
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| series | Frontiers in Oncology |
| spelling | doaj.art-787fecc5805748b28ebb5778da895c772023-02-03T06:07:08ZengFrontiers Media S.A.Frontiers in Oncology2234-943X2023-02-011310.3389/fonc.2023.10897871089787Preoperative individual-target transcranial magnetic stimulation demonstrates an effect comparable to intraoperative direct electrical stimulation in language-eloquent glioma mapping and improves postsurgical outcome: A retrospective fiber-tracking and electromagnetic simulation studySanzhong Li0Yunfeng Mu1Yang Rao2Chuanzhu Sun3Xiang Li4Xiang Li5Huan Liu6Xun Yu7Xiao Yan8Yunxia Ding9Yangtao Wang10Zhou Fei11Department of Neurosurgery, Xijing Hospital, Air Force Medical University, Xi’an, Shaanxi, ChinaDepartment of Gynecological Oncology, Shaanxi Provincial Cancer Hospital, Xi’an, ChinaShaanxi Brain Modulation and Scientific Research Center, Xi'an, Shaanxi, ChinaShaanxi Brain Modulation and Scientific Research Center, Xi'an, Shaanxi, ChinaShaanxi Brain Modulation and Scientific Research Center, Xi'an, Shaanxi, ChinaThe Key Laboratory of Biomedical Information Engineering of Ministry of Education, Institute of Health and Rehabilitation Science, School of Life Science and Technology, Xi’an Jiaotong University, Xi’an, Shaanxi, ChinaSchool of Mathematics and Statistics, Xi’an Jiaotong University, Xi’an, Shaanxi, ChinaProduct Department, Solide Brain Medical Technology, Ltd., Xi’an, Shaanxi, ChinaShaanxi Brain Modulation and Scientific Research Center, Xi'an, Shaanxi, ChinaShaanxi Brain Modulation and Scientific Research Center, Xi'an, Shaanxi, ChinaShaanxi Brain Modulation and Scientific Research Center, Xi'an, Shaanxi, ChinaDepartment of Neurosurgery, Xijing Hospital, Air Force Medical University, Xi’an, Shaanxi, ChinaBackgroundEfforts to resection of glioma lesions located in brain-eloquent areas must balance the extent of resection (EOR) and functional preservation. Currently, intraoperative direct electrical stimulation (DES) is the gold standard for achieving the maximum EOR while preserving as much functionality as possible. However, intraoperative DES inevitably involves risks of infection and epilepsy. The aim of this study was to verify the reliability of individual-target transcranial magnetic stimulation (IT-TMS) in preoperative mapping relative to DES and evaluate its effectiveness based on postsurgical outcomes.MethodsSixteen language-eloquent glioma patients were enrolled. Nine of them underwent preoperative nTMS mapping (n=9, nTMS group), and the other seven were assigned to the non-nTMS group and did not undergo preoperative nTMS mapping (n=7). Before surgery, online IT-TMS was performed during a language task in the nTMS group. Sites in the cortex at which this task was disturbed in three consecutive trials were recorded and regarded as positive and designated nTMS hotspots (HSnTMS). Both groups then underwent awake surgery and intraoperative DES mapping. DES hotspots (HSDES) were also determined in a manner analogous to HSnTMS. The spatial distribution of HSnTMS and HSDES in the nTMS group was recorded, registered in a single brain template, and compared. The center of gravity (CoG) of HSnTMS (HSnTMS-CoG)-based and HSDES-CoG-based diffusion tensor imaging-fiber tracking (DTI-FT) was performed. The electromagnetic simulation was conducted, and the values were then compared between the nTMS and DES groups, as were the Western Aphasia Battery (WAB) scale and fiber-tracking values.ResultsHSnTMS and HSDES showed similar distributions (mean distance 6.32 ± 2.6 mm, distance range 2.2-9.3 mm, 95% CI 3.9-8.7 mm). A higher fractional anisotropy (FA) value in nTMS mapping (P=0.0373) and an analogous fiber tract length (P=0.2290) were observed. A similar distribution of the electric field within the brain tissues induced by nTMS and DES was noted. Compared with the non-nTMS group, the integration of nTMS led to a significant improvement in language performance (WAB scores averaging 78.4 in the nTMS group compared with 59.5 in the non-nTMS group, P=0.0321 < 0.05) as well as in brain-structure preservation (FA value, P=0.0156; tract length, P=0.0166).ConclusionPreoperative IT-TMS provides data equally crucial to DES and thus facilitates precise brain mapping and the preservation of linguistic function.https://www.frontiersin.org/articles/10.3389/fonc.2023.1089787/fulltranscranial magnetic stimulationlanguage mappingfiber-trackingelectromagnetic simulationdeep electrical stimulation |
| spellingShingle | Sanzhong Li Yunfeng Mu Yang Rao Chuanzhu Sun Xiang Li Xiang Li Huan Liu Xun Yu Xiao Yan Yunxia Ding Yangtao Wang Zhou Fei Preoperative individual-target transcranial magnetic stimulation demonstrates an effect comparable to intraoperative direct electrical stimulation in language-eloquent glioma mapping and improves postsurgical outcome: A retrospective fiber-tracking and electromagnetic simulation study Frontiers in Oncology transcranial magnetic stimulation language mapping fiber-tracking electromagnetic simulation deep electrical stimulation |
| title | Preoperative individual-target transcranial magnetic stimulation demonstrates an effect comparable to intraoperative direct electrical stimulation in language-eloquent glioma mapping and improves postsurgical outcome: A retrospective fiber-tracking and electromagnetic simulation study |
| title_full | Preoperative individual-target transcranial magnetic stimulation demonstrates an effect comparable to intraoperative direct electrical stimulation in language-eloquent glioma mapping and improves postsurgical outcome: A retrospective fiber-tracking and electromagnetic simulation study |
| title_fullStr | Preoperative individual-target transcranial magnetic stimulation demonstrates an effect comparable to intraoperative direct electrical stimulation in language-eloquent glioma mapping and improves postsurgical outcome: A retrospective fiber-tracking and electromagnetic simulation study |
| title_full_unstemmed | Preoperative individual-target transcranial magnetic stimulation demonstrates an effect comparable to intraoperative direct electrical stimulation in language-eloquent glioma mapping and improves postsurgical outcome: A retrospective fiber-tracking and electromagnetic simulation study |
| title_short | Preoperative individual-target transcranial magnetic stimulation demonstrates an effect comparable to intraoperative direct electrical stimulation in language-eloquent glioma mapping and improves postsurgical outcome: A retrospective fiber-tracking and electromagnetic simulation study |
| title_sort | preoperative individual target transcranial magnetic stimulation demonstrates an effect comparable to intraoperative direct electrical stimulation in language eloquent glioma mapping and improves postsurgical outcome a retrospective fiber tracking and electromagnetic simulation study |
| topic | transcranial magnetic stimulation language mapping fiber-tracking electromagnetic simulation deep electrical stimulation |
| url | https://www.frontiersin.org/articles/10.3389/fonc.2023.1089787/full |
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