title: Preoperative navigated transcranial magnetic stimulation and tractography in transparietal approach to the trigone of the lateral ventricle.
abstract: OBJECTIVE
  Eloquent neural structures including white matter tracts surround the trigone of the lateral ventricle. Surgical resection of trigonal tumors via the transparietal approach may cause neurological deterioration depending on the trajectory.
  
  
  METHODS
  The authors retrospectively reviewed patients with trigonal tumors that underwent combined preoperative navigated transcranial magnetic stimulation (nTMS) and optic radiation tractography to guide a transparietal approach towards the trigone.
  
  
  RESULTS
  Five patients underwent preoperative nTMS motor mapping, rTMS language mapping, nTMS-derived corticospinal tract tractography, and optic radiation tractography. The information was used to select the optimal trajectory for a transparietal approach and for intraoperative neuronavigation. Four patients underwent surgical resection. None of them experienced a new permanent deficit.
  
  
  CONCLUSIONS
  Combination of preoperative nTMS and optic radiation tractography facilitates the identification of the optimal parietal trajectory towards the trigone. It allows for sparing of visual and motor pathways as well as cortical language areas.
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: Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States; Department of Neurosurgery, Geisinger Health System, Danville, PA, United States.
authors.forename: Christoph J
authors.initials: CJ
authors.lastname: Griessenauer
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, Saarland University Medical Center and Saarland University Faculty of Medicine, Homburg, Saar, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Linsler
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: D000293:Adolescent; D000328:Adult; D000368:Aged; D001932:Brain Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery*; D056324:Diffusion Tensor Imaging / Q000379:methods*; D005260:Female; D006801:Humans; D007806:Language Disorders / Q000209:etiology / Q000517:prevention & control; D020547:Lateral Ventricles / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D038361:Neuronavigation / Q000009:adverse effects / Q000379:methods*; D011183:Postoperative Complications / Q000517:prevention & control*; D011597:Psychomotor Performance; D050781:Transcranial Magnetic Stimulation / Q000379:methods*
keywords: Navigated transcranial magnetic stimulation; Surgery; Tractography; Trigonal approach; Trigone