title: Navigated transcranial magnetic stimulation improves the treatment outcome in patients with brain tumors in motor eloquent locations.
abstract: BACKGROUND
  Neurological and oncological outcomes of motor eloquent brain-tumor patients depend upon the ability to localize functional areas and the respective proposed therapy. We set out to determine whether the use of navigated transcranial magnetic stimulation (nTMS) had an impact on treatment and outcome in patients with brain tumors in motor eloquent locations.
  
  
  METHODS
  We enrolled 250 consecutive patients and compared their functional and oncological outcomes to a matched pre-nTMS control group (n = 115).
  
  
  RESULTS
  nTMS mapping results disproved suspected involvement of primary motor cortex in 25.1% of cases, expanded surgical indication in 14.8%, and led to planning of more extensive resection in 35.2% of cases and more restrictive resection in 3.5%. In comparison with the control group, the rate of gross total resections increased significantly from 42% to 59% (P < .05). Progression-free-survival for low grade glioma was significantly better in the nTMS group at 22.4 months than in control group at 15.4 months (P < .05). Integration of nTMS led to a nonsignificant change of postoperative deficits from 8.5% in the control group to 6.1% in the nTMS group.
  
  
  CONCLUSIONS
  nTMS provides crucial data for preoperative planning and surgical resection of tumors involving essential motor areas. Expanding surgical indications and extent of resection based on nTMS enables more patients to undergo surgery and might lead to better neurological outcomes and higher survival rates in brain tumor patients. The impact of this study should go far beyond the neurosurgical community because it could fundamentally improve treatment and outcome, and its results will likely change clinical practice.
authors.affiliation: Department of Neurosurgery, Charité University Medicine, Berlin, Germany.
authors.forename: Dietmar
authors.initials: D
authors.lastname: Frey
authors.affiliation: Department of Neurosurgery, Charité University Medicine, Berlin, Germany.
authors.forename: Sarah
authors.initials: S
authors.lastname: Schilt
authors.affiliation: Department of Neurosurgery, Charité University Medicine, Berlin, Germany.
authors.forename: Valérie
authors.initials: V
authors.lastname: Strack
authors.affiliation: Department of Neurosurgery, Charité University Medicine, Berlin, Germany.
authors.forename: Anna
authors.initials: A
authors.lastname: Zdunczyk
authors.affiliation: Department of Neurosurgery, Charité University Medicine, Berlin, Germany.
authors.forename: Judith
authors.initials: J
authors.lastname: Rösler
authors.affiliation: Department of Neurosurgery, Charité University Medicine, Berlin, Germany.
authors.forename: Birat
authors.initials: B
authors.lastname: Niraula
authors.affiliation: Department of Neurosurgery, Charité University Medicine, Berlin, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Vajkoczy
authors.affiliation: Department of Neurosurgery, Charité University Medicine, Berlin, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Picht
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001931:Brain Mapping; D001932:Brain Neoplasms / Q000175:diagnosis* / Q000628:therapy*; D018572:Disease-Free Survival; D005260:Female; D005910:Glioma / Q000175:diagnosis* / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009044:Motor Cortex / Q000473:pathology / Q000601:surgery*; D038361:Neuronavigation / Q000379:methods*; D011300:Preoperative Care / Q000379:methods; D011788:Quality of Life; D050781:Transcranial Magnetic Stimulation / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult
keywords: clinical and oncological outcome; diffusion tensor imaging; intraoperative monitoring; motor eloquent brain tumors; navigated transcranial magnetic stimulation