Preoperative Navigated Transcranial Magnetic Stimulation Improves Gross Total Resection Rates in Patients with Motor-Eloquent High-Grade Gliomas: A Matched Cohort Study

医学 磁刺激 运动皮层 胶质瘤 子群分析 队列 比例危险模型 刺激 肿瘤科 置信区间 内科学 癌症研究
作者
Philipp Hendrix,Yvonne Dzierma,Benedikt W. Burkhardt,Andreas Simgen,Gudrun Wagenpfeil,Christoph J. Griessenauer,Sebastian Senger,Joachim Oertel
出处
期刊:Neurosurgery [Oxford University Press]
卷期号:88 (3): 627-636 被引量:21
标识
DOI:10.1093/neuros/nyaa486
摘要

Abstract BACKGROUND Navigated transcranial magnetic stimulation (nTMS) is an established, noninvasive tool to preoperatively map the motor cortex. Despite encouraging reports from few academic centers with vast nTMS experience, its value for motor-eloquent brain surgery still requires further exploration. OBJECTIVE To further elucidate the role of preoperative nTMS in motor-eloquent brain surgery. METHODS Patients who underwent surgery for a motor-eloquent supratentorial glioma or metastasis guided by preoperative nTMS were retrospectively reviewed. The nTMS group (n = 105) was pair-matched to controls (non-nTMS group, n = 105). Gross total resection (GTR) and motor outcome were evaluated. Subgroup analyses including survival analysis for WHO III/IV glioma were performed. RESULTS GTR was significantly more frequently achieved in the entire nTMS group compared to the non-nTMS group ( P = .02). Motor outcome did not differ ( P = .344). Bootstrap analysis confirmed these findings. In the metastases subgroup, GTR rates and motor outcomes were equal. In the WHO III/IV glioma subgroup, however, GTR was achieved more frequently in the nTMS group (72.3%) compared to non-nTMS group (53.2%) ( P = .049), whereas motor outcomes did not differ ( P = .521). In multivariable Cox-regression analysis, prolonged survival in WHO III/IV glioma was significantly associated with achievement of GTR and younger patient age but not nTMS mapping. CONCLUSION Preoperative nTMS improves GTR rates without jeopardizing neurological function. In WHO III/IV glioma surgery, nTMS increases GTR rates that might translate into a beneficial overall survival. The value of nTMS in the setting of a potential survival benefit remains to be determined.
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