title: Implementing Functional Preoperative Mapping in the Clinical Routine of a Neurosurgical Department: Technical Note.
abstract: BACKGROUND
  Navigated transcranial magnetic stimulation (nTMS) is increasingly being used for mapping of various brain functions and in nTMS-based tractography in neurosurgical departments worldwide. When a department begins using nTMS data in the clinical workflow, smooth integration into the hospital's existing infrastructure is mandatory. Standardized approaches for this beyond the mapping or tractography procedures themselves have not yet been described.
  
  
  METHODS
  To create an effective workflow for neurosurgical nTMS mapping, we present the findings of our 7 years of experience and progressive integration into the clinical routine.
  
  
  RESULTS
  After indication for mapping is made, the workflow starts with patient admission and includes all preoperative steps until tumor resection. Importantly, only standard software and devices were used, enabling new centers to easily integrate data derived from nTMS mapping and nTMS-based tractography into their hospital's infrastructure. Registration of the patient, appointment planning, and documentation of results of the nTMS procedures within the hospital information system (HIS) can be achieved by a novel tailored software mask. As another important part of the workflow, nTMS data are imported into the picture archiving and communication system (PACS) via PACS integrator software. In addition, for surgical planning including nTMS-based tractography, nTMS data can be effectively included in surgical neuronavigation software.
  
  
  CONCLUSIONS
  Optimized integration of nTMS data can be achieved using a standardized workflow. The seamless integration and availability of nTMS data are crucial to the acceptance of these data in the clinical routine. This optimized workflow can serve as a guide for centers beginning to use nTMS data in patient care.
authors.affiliation: Department of Neurosurgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; TUM Neuroimaging Center, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.
authors.forename: Nico
authors.initials: N
authors.lastname: Sollmann
authors.affiliation: Department of Neurosurgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.
authors.forename: Bernhard
authors.initials: B
authors.lastname: Meyer
authors.affiliation: Department of Neurosurgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; TUM Neuroimaging Center, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany. Electronic address: Sandro.Krieg@tum.de.
authors.forename: Sandro M
authors.initials: SM
authors.lastname: Krieg
mesh_terms: D001921:Brain / Q000000981:diagnostic imaging* / Q000601:surgery; D001931:Brain Mapping; D001932:Brain Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery; D056324:Diffusion Tensor Imaging; D006748:Hospital Departments / Q000458:organization & administration*; D006801:Humans; D021621:Imaging, Three-Dimensional; D008279:Magnetic Resonance Imaging; D038361:Neuronavigation; D009493:Neurosurgery / Q000458:organization & administration*; D011300:Preoperative Care / Q000379:methods*; D012984:Software; D050781:Transcranial Magnetic Stimulation / Q000379:methods*; D057188:Workflow
keywords: Brain tumor; Clinical workflow; Mapping; Neuronavigation; Tractography; nTMS