title: Comparison between electric-field-navigated and line-navigated TMS for cortical motor mapping in patients with brain tumors.
abstract: For the navigation of transcranial magnetic stimulation (TMS), various techniques are available. Yet, there are two basic principles underlying them all: electric-field-navigated transcranial magnetic stimulation (En-TMS) and line-navigated transcranial magnetic stimulation (Ln-TMS). The current study was designed to compare both methods.
  
  
  
  To explore whether there is a difference in clinical applicability, workflow, and mapping results of both techniques, we systematically compared motor mapping via En-TMS and Ln-TMS in 12 patients suffering from brain tumors.
  
  
  
  The number of motor-positive stimulation spots and the ratio of positive spots per overall stimulation numbers were significantly higher for En-TMS (motor-positive spots: En-TMS vs. Ln-TMS: 128.3 ± 35.0 vs. 41.3 ± 26.8, p < 0.0001; ratio of motor-positive spots per number of stimulations: En-TMS vs. Ln-TMS: 38.0 ± 9.2 % vs. 20.0 ± 14.4 %, p = 0.0031). Distances between the En-TMS and Ln-TMS motor hotspots were 8.3 ± 4.4 mm on the ipsilesional and 8.6 ± 4.5 mm on the contralesional hemisphere (p = 0.9124).
  
  
  
  The present study compares En-TMS and Ln-TMS motor mapping in the neurosurgical context for the first time. Although both TMS systems tested in the present study are explicitly designed for application during motor mapping in patients with brain lesions, there are differences in applicability, workflow, and results between En-TMS and Ln-TMS, which should be distinctly considered during clinical use of the technique. However, to draw final conclusions about accuracy, confirmation of motor-positive Ln-TMS spots by intraoperative stimulation is crucial within the scope of upcoming investigations.
authors.affiliation: Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany.|TUM-Neuroimaging Center, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
authors.forename: Nico
authors.initials: N
authors.lastname: Sollmann
authors.affiliation: Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany.
authors.forename: Moritz F
authors.initials: MF
authors.lastname: Goblirsch-Kolb
authors.affiliation: Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany.|TUM-Neuroimaging Center, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Ille
authors.affiliation: Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany.
authors.forename: Vicki M
authors.initials: VM
authors.lastname: Butenschoen
authors.affiliation: Section of Neuroradiology, Department of Radiology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany.
authors.forename: Tobias
authors.initials: T
authors.lastname: Boeckh-Behrens
authors.affiliation: Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany.
authors.forename: Bernhard
authors.initials: B
authors.lastname: Meyer
authors.affiliation: Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany.
authors.forename: Florian
authors.initials: F
authors.lastname: Ringel
authors.affiliation: Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany. sandro.krieg@tum.de.|TUM-Neuroimaging Center, Klinikum rechts der Isar, Technische Universität München, Munich, Germany. sandro.krieg@tum.de.
authors.forename: Sandro M
authors.initials: SM
authors.lastname: Krieg
mesh_terms: D000328:Adult; D000368:Aged; D001931:Brain Mapping / Q000009:adverse effects / Q000379:methods*; D001932:Brain Neoplasms / Q000601:surgery; D004574:Electromagnetic Fields; D019054:Evoked Potentials, Motor; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009044:Motor Cortex / Q000502:physiology / Q000601:surgery*; D038361:Neuronavigation / Q000009:adverse effects / Q000379:methods*; D050781:Transcranial Magnetic Stimulation / Q000009:adverse effects / Q000379:methods*
keywords: Brain tumor; Cortical mapping; Motor evoked potentials; Navigated transcranial magnetic stimulation; Neuronavigation