title: Navigated brain stimulation for preoperative cortical mapping in paretic patients: case report of a hemiplegic patient.
abstract: BACKGROUND
  Navigated brain stimulation (NBS) is an emerging technology that can be used for preoperative mapping of the motor cortex. It combines conventional transcranial magnetic stimulation with neuronavigation and achieves high precision by taking into account all relevant physical factors. In contrast to functional imaging technologies, NBS does not rely on voluntary patient movements for cortical mapping. Thus, NBS can be used even on patients with severe motor impairment.
  
  
  METHODS
  This article presents the case of a hemiplegic elderly woman with a brain tumor in the motor cortex. Preoperative NBS surprisingly demonstrated intact corticospinal tracts in the hemiplegic patient. The results modified the surgical strategy. Direct cortical stimulation was performed intraoperatively. The direct cortical stimulation results were in agreement with the preoperative NBS findings, and the clinical success of the surgery exceeded expectations.
  
  
  CONCLUSIONS
  NBS can be used for preoperative mapping in plegic patients. Even more important, this case report discusses why tumor resection surgery based on NBS may sometimes lead to substantially better clinical outcomes than surgery planned according to functional imaging technologies.
authors.affiliation: Department of Neurosurgery , Charité-Universitaetsmedizin, Berlin, Germany. thomas.picht@charite.de
authors.forename: Thomas
authors.initials: T
authors.lastname: Picht
authors.forename: Sein
authors.initials: S
authors.lastname: Schmidt
authors.forename: Johannes
authors.initials: J
authors.lastname: Woitzik
authors.forename: Olaf
authors.initials: O
authors.lastname: Suess
mesh_terms: D001931:Brain Mapping / Q000379:methods*; D001932:Brain Neoplasms / Q000150:complications / Q000175:diagnosis* / Q000601:surgery; D005260:Female; D006429:Hemiplegia / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery; D006801:Humans; D008875:Middle Aged; D009044:Motor Cortex / Q000502:physiology*; D038361:Neuronavigation / Q000379:methods*; D011300:Preoperative Care / Q000379:methods; D050781:Transcranial Magnetic Stimulation / Q000379:methods*