title: Integration of navigated brain stimulation data into radiosurgical planning: potential benefits and dangers.
abstract: BACKGROUND
  Radiosurgical treatment of brain lesions near motor or language eloquent areas requires careful planning to achieve the optimal balance between effective dose prescription and preservation of function. Navigated brain stimulation (NBS) is the only non-invasive modality that allows the identification of functionally essential areas by electrical stimulation or inhibition of cortical neurons analogous to the gold-standard of intraoperative electrical mapping.
  
  
  OBJECTIVE
  To evaluate the feasibility of NBS data integration into the radiosurgical environment, and to analyze the influence of NBS data on the radiosurgical treatment planning for lesions near or within motor or language eloquent areas of the brain.
  
  
  METHODS
  Eleven consecutive patients with brain lesions in presumed motor or language eloquent locations eligible for radiosurgical treatment were mapped with NBS. The radiosurgical team prospectively analyzed the data transfer and classified the influence of the functional NBS information on the radiosurgical treatment planning using a standardized questionnaire.
  
  
  RESULTS
  The semi-automatized data transfer to the radiosurgical planning workstation was flawless in all cases. The NBS data influenced the radiosurgical treatment planning procedure as follows: improved risk-benefit balancing in all cases, target contouring in 0 %, dose plan modification in 81.9 %, reduction of radiation dosage in 72.7 % and treatment indication in 63.7 % of the cases.
  
  
  CONCLUSIONS
  NBS data integration into radiosurgical treatment planning is feasible. By mapping the spatial relationship between the lesion and functionally essential areas, NBS has the potential to improve radiosurgical planning safety for eloquently located lesions.
authors.affiliation: Department of Neurosurgery, Charité University Hospital, Augustenburger Platz 1, 13353, Berlin, Germany, thomas.picht@charite.de.
authors.forename: Thomas
authors.initials: T
authors.lastname: Picht
authors.forename: Sarah
authors.initials: S
authors.lastname: Schilt
authors.forename: Dietmar
authors.initials: D
authors.lastname: Frey
authors.forename: Peter
authors.initials: P
authors.lastname: Vajkoczy
authors.forename: Markus
authors.initials: M
authors.lastname: Kufeld
mesh_terms: D000328:Adult; D000368:Aged; D001931:Brain Mapping / Q000379:methods*; D001932:Brain Neoplasms / Q000601:surgery*; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007802:Language; D008297:Male; D008875:Middle Aged; D016634:Radiosurgery / Q000379:methods* / Q000592:standards; D018570:Risk Assessment; D025321:Surgery, Computer-Assisted / Q000379:methods* / Q000592:standards; D050781:Transcranial Magnetic Stimulation / Q000379:methods*