title: Preoperative motor mapping by navigated transcranial magnetic brain stimulation improves outcome for motor eloquent lesions.
abstract: BACKGROUND
  Navigated transcranial magnetic stimulation (nTMS) has been proven to influence surgical indication and planning. Yet there is still no clear evidence how these additional preoperative functional data influence the clinical course and outcome. Thus, this study aimed to compare patients with motor eloquently located supratentorial lesions investigated with or without preoperative nTMS in terms of clinical outcome parameters.
  
  
  METHODS
  A prospectively enrolled cohort of 100 patients with supratentorial lesions located in motor eloquent areas was investigated by preoperative nTMS (2010-2013) and matched with a control of 100 patients who were operated on without nTMS data (2006-2010) by a matched pair analysis.
  
  
  RESULTS
  Patients in the nTMS group showed a significantly lower rate of residual tumor on postoperative MRI (OR 0.3828; 95% CI 0.2062-0.7107). Twelve percent of patients in the nTMS and 1% of patients in the non-nTMS group improved while 75% and 81% of the nTMS and non-nTMS groups, respectively, remained unchanged and 13% and 18% of patients in the nTMS and non-nTMS groups, respectively, deteriorated in postoperative motor function on long-term follow-up (P = .0057). Moreover, the nTMS group showed smaller craniotomies (nTMS 22.4 ± 8.3 cm(2); non-nTMS 26.7 ± 11.3 cm(2); P = .0023).
  
  
  CONCLUSIONS
  This work increases the level of evidence for preoperative motor mapping by nTMS for rolandic lesions in a group comparison study. We therefore strongly advocate nTMS to become increasingly used for these lesions. However, a randomized trial on the comparison with the gold standard of intraoperative mapping seems mandatory.
authors: Department of Neurosurgery (S.M.K., J.S., L.B., T.O., C.N., I.J., E.S., B.M., F.R.); TUM-Neuroimaging Center, Klinikum rechts der Isar, TU München, Germany (S.M.K., J.S., L.B., T.O.).
authors: Sandro M
authors: SM
authors: Krieg
authors: Department of Neurosurgery (S.M.K., J.S., L.B., T.O., C.N., I.J., E.S., B.M., F.R.); TUM-Neuroimaging Center, Klinikum rechts der Isar, TU München, Germany (S.M.K., J.S., L.B., T.O.).
authors: Jamil
authors: J
authors: Sabih
authors: Department of Neurosurgery (S.M.K., J.S., L.B., T.O., C.N., I.J., E.S., B.M., F.R.); TUM-Neuroimaging Center, Klinikum rechts der Isar, TU München, Germany (S.M.K., J.S., L.B., T.O.).
authors: Lucia
authors: L
authors: Bulubasova
authors: Department of Neurosurgery (S.M.K., J.S., L.B., T.O., C.N., I.J., E.S., B.M., F.R.); TUM-Neuroimaging Center, Klinikum rechts der Isar, TU München, Germany (S.M.K., J.S., L.B., T.O.).
authors: Thomas
authors: T
authors: Obermueller
authors: Department of Neurosurgery (S.M.K., J.S., L.B., T.O., C.N., I.J., E.S., B.M., F.R.); TUM-Neuroimaging Center, Klinikum rechts der Isar, TU München, Germany (S.M.K., J.S., L.B., T.O.).
authors: Chiara
authors: C
authors: Negwer
authors: Department of Neurosurgery (S.M.K., J.S., L.B., T.O., C.N., I.J., E.S., B.M., F.R.); TUM-Neuroimaging Center, Klinikum rechts der Isar, TU München, Germany (S.M.K., J.S., L.B., T.O.).
authors: Insa
authors: I
authors: Janssen
authors: Department of Neurosurgery (S.M.K., J.S., L.B., T.O., C.N., I.J., E.S., B.M., F.R.); TUM-Neuroimaging Center, Klinikum rechts der Isar, TU München, Germany (S.M.K., J.S., L.B., T.O.).
authors: Ehab
authors: E
authors: Shiban
authors: Department of Neurosurgery (S.M.K., J.S., L.B., T.O., C.N., I.J., E.S., B.M., F.R.); TUM-Neuroimaging Center, Klinikum rechts der Isar, TU München, Germany (S.M.K., J.S., L.B., T.O.).
authors: Bernhard
authors: B
authors: Meyer
authors: Department of Neurosurgery (S.M.K., J.S., L.B., T.O., C.N., I.J., E.S., B.M., F.R.); TUM-Neuroimaging Center, Klinikum rechts der Isar, TU München, Germany (S.M.K., J.S., L.B., T.O.).
authors: Florian
authors: F
authors: Ringel
mesh_terms: D001931:Brain Mapping; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009044:Motor Cortex / Q000601:surgery*; D038361:Neuronavigation; D011300:Preoperative Care; D011446:Prospective Studies; D015173:Supratentorial Neoplasms / Q000601:surgery*; D050781:Transcranial Magnetic Stimulation; D016896:Treatment Outcome
keywords: brain tumor; matched pair; preoperative mapping; rolandic region; transcranial magnetic stimulation