title: Functional Reconstruction of Motor and Language Pathways Based on Navigated Transcranial Magnetic Stimulation and DTI Fiber Tracking for the Preoperative Planning of Low Grade Glioma Surgery: A New Tool for Preservation and Restoration of Eloquent Networks.
abstract: Surgery of low-grade gliomas (LGGs) in eloquent areas still presents a challenge. New technologies have been introduced to enable the performance of "functional", customized preoperative planning aimed at maximal resection, while reducing the risk of postoperative deficits. We describe our experience in the surgery of LGGs in eloquent areas using preoperative planning based on navigated transcranial magnetic stimulation (nTMS) and diffusion tensor imaging (DTI) tractography.
  
  
  
  Sixteen patients underwent preoperative planning, using nTMS and nTMS-based DTI tractography. Motor and language functions were mapped. Preoperative data allowed for tailoring of the surgical strategy. The impact of these modalities on surgical planning was evaluated. Influence on functional outcome was analyzed in comparison with results in a historical control group.
  
  
  
  In 12 patients (75 %), nTMS added useful information on functional anatomy and surgical risks. Surgical strategy was modified in 9 of 16 cases (56 %). The nTMS "functional approach" provided a good outcome at discharge, with a decrease in postoperative motor and/or language deficits, as compared with controls (6 vs. 44 %; p = 0.03).
  
  
  
  The functional preoperative mapping of speech and motor pathways based on nTMS and DTI tractography provided useful information, allowing us to plan the best surgical strategy for radical resection; this resulted in improved postoperative neurological results.
authors.affiliation: Department of Neuroscience, Neurosurgical Clinic, University of Messina, Messina, Italy. mark83g@alice.it.|Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy. mark83g@alice.it.|A.O.U. Policlinico "G. Martino", Via Consolare Valeria, 1, Messina, 98125, Italy. mark83g@alice.it.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Raffa
authors.affiliation: Department of Neuroscience, Neurosurgical Clinic, University of Messina, Messina, Italy.
authors.forename: Alfredo
authors.initials: A
authors.lastname: Conti
authors.affiliation: Department of Neuroscience, Neurosurgical Clinic, University of Messina, Messina, Italy.
authors.forename: Antonino
authors.initials: A
authors.lastname: Scibilia
authors.affiliation: Department of Neuroscience, Neurosurgical Clinic, University of Messina, Messina, Italy.|Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy.
authors.forename: Carmela
authors.initials: C
authors.lastname: Sindorio
authors.affiliation: Department of Cognitive Sciences, Psychology, Pedagogy and Cultural Studies, University of Messina, Messina, Italy.
authors.forename: Maria Catena
authors.initials: MC
authors.lastname: Quattropani
authors.affiliation: Institute of Neurosurgery, Medical School, Catholic University of Rome, Rome, Italy.
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Visocchi
authors.affiliation: Department of Neuroscience, Neurosurgical Clinic, University of Messina, Messina, Italy.
authors.forename: Antonino
authors.initials: A
authors.lastname: Germanò
authors.affiliation: Department of Neuroscience, Neurosurgical Clinic, University of Messina, Messina, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Tomasello
mesh_terms: D000328:Adult; D000368:Aged; D001932:Brain Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D056324:Diffusion Tensor Imaging; D004525:Efferent Pathways / Q000000981:diagnostic imaging* / Q000601:surgery; D005260:Female; D005910:Glioma / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D006801:Humans; D007802:Language; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009434:Neural Pathways / Q000000981:diagnostic imaging / Q000601:surgery; D038361:Neuronavigation / Q000379:methods*; D019635:Neurosurgical Procedures / Q000379:methods*; D050781:Transcranial Magnetic Stimulation
keywords: Arcuate fasciculus; Brain tumors; Corticospinal tract; DTI tractography; Low-grade gliomas; Navigated transcranial magnetic stimulation