title: Safety and tolerability of navigated TMS for preoperative mapping in neurosurgical patients.
abstract: OBJECTIVE
  Navigated transcranial magnetic stimulation (nTMS) is a non-invasive technique for pre-surgical motor and language mapping in patients with brain lesions. This study examines the safety and tolerability of nTMS in a large, multi-center cohort of neurosurgical patients.
  
  
  METHODS
  Functional mapping with monopulse and repetitive nTMS was performed in 733 patients. In this cohort, 57% of patients had left-sided tumors, 50% had frontal tumors, and 50% had seizures secondary to the lesion. Side effects and pain intensity related to the procedure were documented.
  
  
  RESULTS
  Patients undergoing monopulse stimulation underwent an average of 490 pulses while those undergoing repetitive stimulation received an average of 2268 pulses. During monopulse stimulation, 5.1% reported discomfort (VAS 1-3), and 0.4% reported pain (VAS>3). During repetitive stimulation, 23.4% reported discomfort and 69.5% reported pain. No seizures or other adverse events were observed.
  
  
  CONCLUSIONS
  nTMS is safe and well-tolerated in neurosurgical patients. Clinicians should consider expanding nTMS to patients with frequent seizures, but more evaluation is necessary to evaluate this risk fully.
  
  
  CONCLUSIONS
  nTMS is safe and well-tolerated, even in neurosurgical patients with persistent occasional seizure secondary to a lesion. It should be considered in any patient with a lesion in a presumed peri-eloquent or eloquent brain region.
authors.affiliation: Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA. Electronic address: taraporep@neurosurg.ucsf.edu.
authors.forename: Phiroz E
authors.initials: PE
authors.lastname: Tarapore
authors.affiliation: Department of Neurosurgery, Charité-Universitätsmedizin, Berlin, Germany. Electronic address: thomas.picht@charite.de.
authors.forename: Thomas
authors.initials: T
authors.lastname: Picht
authors.affiliation: Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675 Munich, Germany. Electronic address: L.Bulubas@gmail.com.
authors.forename: Lucia
authors.initials: L
authors.lastname: Bulubas
authors.affiliation: Department of Neurosurgery, Nara Medical University, Japan. Electronic address: y-shin@fb3.so-net.ne.jp.
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Shin
authors.affiliation: Department of Neurosurgery, Charité-Universitätsmedizin, Berlin, Germany. Electronic address: kulchytska.natalia@gmail.com.
authors.forename: Natalia
authors.initials: N
authors.lastname: Kulchytska
authors.affiliation: Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675 Munich, Germany. Electronic address: Bernhard.Meyer@tum.de.
authors.forename: Bernhard
authors.initials: B
authors.lastname: Meyer
authors.affiliation: Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA. Electronic address: Mitchel.berger@ucsf.edu.
authors.forename: Mitchel S
authors.initials: MS
authors.lastname: Berger
authors.affiliation: Department of Radiology, University of California, San Francisco, San Francisco, CA, USA. Electronic address: Srikantan.Nagarajan@ucsf.edu.
authors.forename: Srikantan S
authors.initials: SS
authors.lastname: Nagarajan
authors.affiliation: Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675 Munich, Germany. Electronic address: Sandro.Krieg@tum.de.
authors.forename: Sandro M
authors.initials: SM
authors.lastname: Krieg
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001931:Brain Mapping / Q000009:adverse effects / Q000379:methods*; D001932:Brain Neoplasms / Q000175:diagnosis / Q000601:surgery*; D002648:Child; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D038361:Neuronavigation / Q000009:adverse effects / Q000379:methods*; D010146:Pain / Q000209:etiology; D011300:Preoperative Care / Q000379:methods*; D011446:Prospective Studies; D050781:Transcranial Magnetic Stimulation / Q000009:adverse effects / Q000379:methods*; D055815:Young Adult
keywords: Eloquent brain tumor; Language mapping; Motor mapping; Navigated transcranial magnetic stimulation, nTMS; Pre-operative mapping; Transcranial magnetic stimulation, TMS