title: Preoperative rTMS Language Mapping in Speech-Eloquent Brain Lesions Resected Under General Anesthesia: A Pair-Matched Cohort Study.
abstract: OBJECTIVE
  The value of preoperative repetitive transcranial magnetic stimulation (rTMS) language mapping for function preservation in surgery of speech-eloquent lesions under general anesthesia remains to be determined.
  
  
  METHODS
  We prospectively enrolled 20 consecutive right-handed patients with a malignant, left-sided perisylvian language-eloquent brain tumor. All patients were subjected to surgical resection under general anesthesia guided by preoperative rTMS language mapping (rTMS group, 2014-2016). A matched-pair analysis with 20 patients who also underwent surgical resection under general anesthesia in the pre-rTMS era (pre-rTMS group, 2009-2013) was performed. Language performance status was ranked from grade 0 to grade 3 (none, mild, medium, severe).
  
  
  RESULTS
  Rates of gross total resection, tumor residual, and complications were equal in both groups. Duration of surgery (P = 0.039) and inpatient stay (P = 0.001) were significantly shorter in the rTMS group. Preoperatively, 14 patients in the rTMS and 13 patients in the pre-rTMS group had language deficits (P = 0.380). One week after surgery, 8/14 patients (57.1%) in the rTMS group but only 1/13 patients (7.7%) in the pre-rTMS group experienced improvement of language performance status (P = 0.013). At 6 weeks follow-up, language performance status was significantly better in the rTMS group (P = 0.048). However, at 3 months follow-up, the rTMS and pre-rTMS groups showed an equal language performance status.
  
  
  CONCLUSIONS
  Implementation of preoperative rTMS language mapping seems to provide a favorable early language outcome in patients undergoing surgical resection of language-eloquent lesions under general anesthesia.
authors.affiliation: Department of Neurosurgery, Saarland University Medical Center and Saarland University Faculty of Medicine, Homburg/Saar, Germany. Electronic address: hendrix.philipp@gmail.com.
authors.forename: Philipp
authors.initials: P
authors.lastname: Hendrix
authors.affiliation: Department of Neurosurgery, Saarland University Medical Center and Saarland University Faculty of Medicine, Homburg/Saar, Germany.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Senger
authors.affiliation: Department of Neuroradiology, Saarland University Medical Center and Saarland University Faculty of Medicine, Homburg/Saar, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Simgen
authors.affiliation: Department of Neurosurgery, Geisinger Health System, Danville, Pennsylvania, USA.
authors.forename: Christoph J
authors.initials: CJ
authors.lastname: Griessenauer
authors.affiliation: Department of Neurosurgery, Saarland University Medical Center and Saarland University Faculty of Medicine, Homburg/Saar, Germany.
authors.forename: Joachim
authors.initials: J
authors.lastname: Oertel
mesh_terms: D000368:Aged; D000768:Anesthesia, General / Q000379:methods*; D001931:Brain Mapping / Q000379:methods*; D001932:Brain Neoplasms / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007802:Language; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care / Q000379:methods*; D011446:Prospective Studies; D013060:Speech / Q000502:physiology*; D050781:Transcranial Magnetic Stimulation / Q000379:methods*
keywords: General anesthesia; Navigated repetitive transcranial magnetic stimulation; Preoperative language mapping