title: Reappraisal of the anatomical landmarks of motor and premotor cortical regions for image-guided brain navigation in TMS practice.
abstract: Image-guided navigation systems dedicated to transcranial magnetic stimulation (TMS) have been recently developed and offer the possibility to visualize directly the anatomical structure to be stimulated. Performing navigated TMS requires a perfect knowledge of cortical anatomy, which is very variable between subjects. This study aimed at providing a detailed description of sulcal and gyral anatomy of motor cortical regions with special interest to the inter-individual variability of sulci. We attempted to identify the most stable structures, which can serve as anatomical landmarks for motor cortex mapping in navigated TMS practice. We analyzed the 3D reconstruction of 50 consecutive healthy adult brains (100 hemispheres). Different variants were identified regarding sulcal morphology, but several anatomical structures were found to be remarkably stable (four on dorsoventral axis and five on rostrocaudal axis). These landmarks were used to define a grid of 12 squares, which covered motor cortical regions. This grid was used to perform motor cortical mapping with navigated TMS in 12 healthy subjects from our cohort. The stereotactic coordinates (x-y-z) of the center of each of the 12 squares of the mapping grid were expressed into the standard Talairach space to determine the corresponding functional areas. We found that the regions whose stimulation produced almost constantly motor evoked potentials mainly correspond to the primary motor cortex, with rostral extension to premotor cortex and caudal extension to posterior parietal cortex. Our anatomy-based approach should facilitate the expression and the comparison of the results obtained in motor mapping studies using navigated TMS.
authors.affiliation: EA 4391, Excitabilité Nerveuse et Thérapeutique, Université Paris-Est-Créteil, Créteil, France; Service de Physiologie-Explorations Fonctionnelles, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris, Créteil, France; Neuroscience Department, University Medical Center Rizk Hospital, Beirut, Lebanon.
authors.forename: Rechdi
authors.initials: R
authors.lastname: Ahdab
authors.forename: Samar S
authors.initials: SS
authors.lastname: Ayache
authors.forename: Wassim H
authors.initials: WH
authors.lastname: Farhat
authors.forename: Veit
authors.initials: V
authors.lastname: Mylius
authors.forename: Sein
authors.initials: S
authors.lastname: Schmidt
authors.forename: Pierre
authors.initials: P
authors.lastname: Brugières
authors.forename: Jean-Pascal
authors.initials: JP
authors.lastname: Lefaucheur
mesh_terms: D000328:Adult; D001931:Brain Mapping; D004569:Electroencephalography; D019054:Evoked Potentials, Motor / Q000502:physiology*; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D019018:Imagery, Psychotherapy; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009044:Motor Cortex / Q000033:anatomy & histology* / Q000502:physiology*; D050781:Transcranial Magnetic Stimulation; D055815:Young Adult
keywords: motor cortex; premotor cortex; sulcal anatomy; transcranial magnetic stimulation
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