Abstract
Brain tumors within or close to motor areas impair not only the motor cortex but also subcortical pathways. Such impairment can be subclinical but nonetheless increases the risk of surgery-related neurological deficits.
Many methods of functional brain mapping are able to demonstrate the topographical relationship between tumor and cortex; nTMS, however, can also assess the functional status of the motor system in brain tumor patients by measuring corticospinal excitability (CSE).
This chapter reviews data on various parameters of motor-evoked potentials for CSE and how these parameters might enable us to estimate the integrity of the motor system: recruitment curve, cortical silent period, and resting motor threshold (rMT). Moreover, the rMT ratio between tumor and healthy hemispheres is presented as a tool for preoperative risk stratification in motor cortex-related surgery. Such nTMS-based neurophysiological data can impact on balancing risks and benefits prior to surgery, counseling patients, planning surgeries, and—as a consequence—on the patients’ outcome, survival, and quality of life.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Amassian VE, Maccabee PJ, Cracco RQ. Focal stimulation of human peripheral nerve with the magnetic coil: a comparison with electrical stimulation. Exp Neurol. 1989;103:282–9.
Awiszus F. TMS and threshold hunting. Suppl Clin Neurophysiol. 2003;56:13–23.
Bashir S, Perez JM, Horvath JC, Pena-Gomez C, Vernet M, Capia A, et al. Differential effects of motor cortical excitability and plasticity in young and old individuals: a transcranial magnetic stimulation (TMS) study. Front Aging Neurosci. 2014;6:111.
Bisdas S, Ritz R, Bender B, Braun C, Pfannenberg C, Reimold M, Naegele T, Ernemann U. Metabolic mapping of gliomas using hybrid MR-PET imaging: feasibility of the method and spatial distribution of metabolic changes. Invest Radiol. 2013;48(5):295–301. doi:10.1097/RLI.0b013e31827188d6. PubMed PMID: 23296081
Boroojerdi B, Battaglia F, Muellbacher W, Cohen LG. Mechanisms influencing stimulus-response properties of the human corticospinal system. Clin Neurophysiol. 2001;112:931–7.
Cantello R, Gianelli M, Civardi C, Mutani R. Magnetic brain stimulation: the silent period after the motor evoked potential. Neurology. 1992;42:1951–9.
Cantello R, Tarletti R, Civardi C. Transcranial magnetic stimulation and Parkinson’s disease. Brain Res Brain Res Rev. 2002;38(3):309–27. Review. PubMed PMID: 11890979
Catana C, Procissi D, Wu Y, et al. Simultaneous in vivo positron emission tomography and magnetic resonance imaging. Proc Natl Acad Sci U S A. 2008;105:3705–10.
Chen R, Lozano AM, Ashby P. Mechanism of the silent period following transcranial magnetic stimulation. Evidence from epidural recordings. Exp Brain Res. 1999;128:539–42.
Chen R, Cros D, Curra A, Di Lazzaro V, Lefaucheur JP, Magistris MR, Mills K, Rosler KM, Triggs WJ, Ugawa Y, Ziemann U. The clinical diagnostic utility of transcranial magnetic stimulation: report of an IFCN committee. Clin Neurophysiol. 2008;119:504–32.
Cicinelli P, Pasqualetti P, Zaccagnini M, Traversa R, Oliveri M, Rossini PM. Interhemispheric asymmetries of motor cortex excitability in the postacute stroke stage: a paired-pulse transcranial magnetic stimulation study. Stroke. 2003;34:2653–8. PubMed: 14551397
Darling WG, Wolf SL, Butler AJ. Variability of motor potentials evoked by transcranial magnetic stimulation depends on muscle activation. Exp Brain Res. 2006;174:376–85.
Devanne H, Lavoie BA, Capaday C. Input-output properties and gain changes in the human corticospinal pathway. Exp Brain Res. 1997;114:329–38.
Dinov ID, Petrosyan P, Liu Z, Eggert P, Zamanyan A, Torri F, Macciardi F, Hobel S, Moon SW, Sung YH, Jiang Z, Labus J, Kurth F, Ashe-McNalley C, Mayer E, Vespa PM, Van Horn JD, Toga AW. The perfect neuroimaging-genetics-computation storm: collision of petabytes of data, millions of hardware devices and thousands of software tools. Brain Imaging Behav. 2014;8(2):311–22.
Frey D, Schilt S, Strack V, Zdunczyk A, Rösler J, Niraula B, et al. Navigated transcranial magnetic stimulation improves the treatment outcome in patients with brain tumors in motor eloquent locations. Neuro Oncol. 2014;16:1365–72.
Fuhr P, Agostino R, Hallett M. Spinal motor neuron excitability during the silent period after cortical stimulation. Electroencephalogr Clin Neurophysiol. 1991;81(4):257–62. PubMed PMID: 1714819.
Grefkes C, Eickhoff SB, Nowak DA, Dafotakis M, Fink GR. Dynamic intra- and interhemispheric interactions during unilateral and bilateral hand movements assessed with fMRI and DCM. Neuroimage. 2008;41(4):1382–94. doi:10.1016/j.neuroimage.2008.03.048. PubMed PMID: 18486490
Hou BL, Bradbury M, Peck KK, Petrovich NM, Gutin PH, Holodny AI. Effect of brain tumor neovasculature defined by rCBV on BOLD fMRI activation volume in the primary motor cortex. Neuroimage. 2006;32(2):489–97.
Hund M, Rezai AR, Kronberg E, Cappell J, Zonenshayn M, Ribary U, Kelly PJ, Llinás R. Magnetoencephalographic mapping: basic of a new functional risk profile in the selection of patients with cortical brain lesions. Neurosurgery. 1997;40(5):936–42. discussion 942–3. PubMed PMID: 9149251
Inghilleri M, Berardelli A, Cruccu G, Manfredi M. Silent period evoked by transcranial stimulation of the human cortex and cervicomedullary junction. J Physiol. 1993;466:521–34.
Julkunen P, Säisänen L, Danner N, Niskanen E, Hukkanen T, Mervaala E, Könönen M. Comparison of navigated and non-navigated transcranial magnetic stimulation for motor cortex mapping, motor threshold and motor evoked potentials. Neuroimage. 2009;44(3):790–5. doi:10.1016/j.neuroimage.2008.09.040. PubMed PMID: 18976714
Julkunen P, Säisänen L, Danner N, Awiszus F, Könönen M. Within-subject effect of coil-to-cortex distance on cortical electric field threshold and motor evoked potentials in transcranial magnetic stimulation. J Neurosci Methods. 2012;206:158–64.
Kekhia H, Rigolo L, Norton I, Golby AJ. Special surgical considerations for functional brain mapping. Neurosurg Clin N Am. 2011;22(2):111–32. doi:10.1016/j.nec.2011.01.004.
Kiers L, Cros D, Chiappa K, Fang JJ. Correlation between twitch and motor evokedpotential (Mep) amplitude produced by magnetic cortical stimulation (Mcs) – effect of stimulus-intensity (Si). Neurology. 1993;43:257–61.
Kimiskidis VK, Papagiannopoulos S, Sotirakoglou K, et al. Silent period to transcranial magnetic stimulation: construction and properties of stimulus-response curves in healthy volunteers. Exp Brain Res. 2005;163:21–31.
Krishnan R, Raabe A, Hattingen E, Szelenyi A, Yahya H, Hermann E, et al. Functional magnetic resonance imaging-integrated neuronavigation: correlation between lesion-to-motor cortex distance and outcome. Neurosurgery. 2004;55(4):904–14. discussion 914–5
Laakso I, Hirata A, Ugawa Y. Effects of coil orientation on the electric field induced by TMS over the hand motor area. Phys Med Biol. 2014;59:203–18.
Lehericy S, Duffau H, Cornu P, Capelle L, Pidoux B, Carpentier A, et al. Correspondence between functional magnetic resonance imaging somatotopy and individual brain anatomy of the central region: comparison with intraoperative stimulation in patients with brain tumors. J Neurosurg. 2000;92(4):589–98.
Mahvash M, Maslehaty H, Jansen O, Mehdorn HM, Petridis AK. Functional magnetic resonance imaging of motor and language for preoperative planning of neurosurgical procedures adjacent to functional areas. Clin Neurol Neurosurg. 2014;123:72–7. doi:10.1016/j.clineuro.2014.05.011. PubMed PMID: 25012016
Mars RB, Bestmann S, Rothwell JC, Haggard P. Effects of motor preparation and spatial attention on corticospinal excitability in a delayed-response paradigm. Exp Brain Res. 2007;182:125–9.
McDonnell MN, Orekhov Y, Ziemann U. The role of GABA(B) receptors in intracortical inhibition in the human motor cortex. Exp Brain Res. 2006;173(1):86–93. PubMed PMID: 16489434
Nagarajan S, Kirsch H, Lin P, Findlay A, Honma S, Berger MS. Preoperative localization of hand motor cortex by adaptive spatial filtering of magnetoencephalography data. J Neurosurg. 2008;109(2):228–37. doi:10.3171/JNS/2008/109/8/0228. PubMed PMID: 18671634
Ojemann JG, Neil JM, MacLeod AM, Silbergeld DL, Dacey RG Jr, Petersen SE, et al. Increased functional vascular response in the region of a glioma. J Cereb Blood Flow Metab. 1998;18(2):148–53.
Orth M, Rothwell JC. The cortical silent period: intrinsic variability and relation to the waveform of the transcranial magnetic stimulation pulse. Clin Neurophysiol. 2004;115(5):1076–82. PubMed PMID: 15066533
Perez MA, Cohen LG. The corticospinal system and transcranial magnetic stimulation in stroke. Top Stroke Rehabil. 2009;16:254–69.
Petrella JR, Shah LM, Harris KM, Friedman AH, George TM, Sampson JH, Pekala JS, Voyvodic JT. Preoperative functional MR imaging localization of language and motor areas: effect on therapeutic decision making in patients with potentially resectable brain tumors. Radiology. 2006;240(3):793–802. PubMed PMID: 16857981
Picht T, Strack V, Schulz J, Zdunczyk A, Frey D, Schmidt S, Vajkoczy P. Assessing the functional status of the motor system in brain tumor patients using transcranial magnetic stimulation. Acta Neurochir (Wien). 2012;154(11):2075–81. doi:10.1007/s00701-012-1494-y. PubMed PMID: 22948747
Rosenstock T, Grittner U, Acker G, Schwarzer V, Kulchytska N, Vajkoczy P, Picht T. Risk stratification in motor area-related glioma surgery based on navigated transcranial magnetic stimulation data. J Neurosurg. 2017;126(4):1227–37. PubMed PMID: 27257834
Rossini PM, Barker AT, Berardelli A, Caramia MD, Caruso G, Cracco RQ, Dimitrijevic MR, Hallett M, Katayama Y, Lucking CH, et al. Non-invasive electrical and magnetic stimulation of the brain, spinal cord and roots: basic principles and procedures for routine clinical application. Report of an IFCN committee. Electroencephalogr Clin Neurophysiol. 1994;91:79–92.
Rutten GJ, Ramsey NF. The role of functional magnetic resonance imaging in brain surgery. Neurosurg Focus. 2010;28(2):E4.
Säisänen L, Julkunen P, Niskanen E, Danner N, Hukkanen T, Lohioja T, Nurkkala J, Mervaala E, Karhu J, Könönen M. Motor potentials evoked by navigated transcranial magnetic stimulation in healthy subjects. J Clin Neurophysiol. 2008;25:367–72.
Sale MV, Semmler JG. Age-related differences in corticospinal control during functional isometric contractions in left and right hands. J Appl Physiol (1985). 2005;99(4):1483–93. PubMed PMID: 15947031
Smits A, Baumert BG. The clinical value of PET with amino acid tracers for gliomas WHO grade II. Int J Mol Imaging. 2011;2011:372509.
Tarapore PE, Martino J, Guggisberg AG, Owen J, Honma SM, Findlay A, et al. Magnetoencephalographic imaging of resting-state functional connectivity predicts postsurgical neurological outcome in brain gliomas. Neurosurgery. 2012a;71(5):1012–22.
Tarapore PE, Tate MC, Findlay AM, Honma SM, Mizuiri D, Berger MS, et al. Preoperative multimodal motor mapping: a comparison of magnetoencephalography imaging, navigated transcranial magnetic stimulation, and direct cortical stimulation. J Neurosurg. 2012b;117(2):354–62.
Thielscher A, Opitz A, Windhoff M. Impact of the gyral geometry on the electric field induced by transcranial magnetic stimulation. Neuroimage. 2011;54:234–43.
Tomczak RJ, Wunderlich AP, Wang Y, Braun V, Antoniadis G, Görich J, et al. fMRI for preoperative neurosurgical mapping of motor cortex and language in a clinical setting. J Comput Assist Tomogr. 2000;24:927–34.
Vitikainen AM, Lioumis P, Paetau R, Salli E, Komssi S, Metsahonkala L, et al. Combined use of non-invasive techniques for improved functional localization for a selected group of epilepsy surgery candidates. Neuroimage. 2009;45(2):342–8.
Wehner T. The role of functional imaging in the tumor patient. Epilepsia. 2013;54(Suppl 9):44–9. doi:10.1111/epi.12443. Review. PubMed PMID: 24328872
Wengenroth M, Blatow M, Guenther J, et al. Diagnostic benefits of presurgical fMRI in patients with brain tumours in the primary sensorimotor cortex. Eur Radiol. 2011;21(7):1517–25.
Yingling CD, Ojemann S, Dodson B, Harrington MJ, Berger MS. Identification of motor pathways during tumor surgery facilitated by multichannel electro-myographic recording. J Neurosurg. 1999;91:922–7. [PubMed]
Zdunczyk A, Fleischmann R, Schulz J, Vajkoczy P, Picht T. The reliability of topographic measurements from navigated transcranial magnetic stimulation in healthy volunteers and tumor patients. Acta Neurochir (Wien). 2013;155:1309–17.
Author information
Authors and Affiliations
Corresponding authors
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2017 Springer International Publishing AG
About this chapter
Cite this chapter
Nikolenko, O., Picht, T. (2017). Risk Stratification by nTMS via Corticospinal Excitability in Motor Cortex-Related Surgery. In: M. Krieg, S. (eds) Navigated Transcranial Magnetic Stimulation in Neurosurgery. Springer, Cham. https://doi.org/10.1007/978-3-319-54918-7_7
Download citation
DOI: https://doi.org/10.1007/978-3-319-54918-7_7
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-54917-0
Online ISBN: 978-3-319-54918-7
eBook Packages: MedicineMedicine (R0)