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Application of Navigated Transcranial Magnetic Stimulation (nTMS) to Study the Visual-Spatial Network and Prevent
Camilla Bonaudo1, Elisa Castaldi2, Agnese Pedone1
1Neurosurgery, Department of Neuroscience, Psychology, Pharmacology and Child Health, University Hospital of Careggi, University of Florence, 50134 Florence, Italy.
Cancers
|January 8, 2025
Summary
Navigated transcranial magnetic stimulation (nTMS) effectively maps visuospatial (VS) functions in neurosurgical patients, aiding preoperative planning and minimizing cognitive impairment. This study highlights nTMS
Area of Science:
- Neurosurgery
- Cognitive Neuroscience
- Neuroimaging
Background:
- Visuospatial (VS) circuits are critical for numerous cognitive functions.
- The application of navigated transcranial magnetic stimulation (nTMS) to study VS functions in neurosurgical oncology patients remains underexplored.
- Preoperative mapping of VS networks is essential for minimizing neurological deficits during brain surgery.
Purpose of the Study:
- To investigate the utility of repetitive nTMS (rnTMS) for mapping VS functions in neurosurgical oncological patients.
- To identify potential subcortical circuits involved in VS processing using nTMS-based tractography.
- To compare the accuracy of nTMS with direct cortical stimulation (DCS) during awake neurosurgery.
Main Methods:
- A prospective monocentric study involving 27 patients with intra-axial brain lesions.
- Utilized rnTMS for preoperative mapping of VS functions, including a novel integrated VS test (VISA).
- Employed nTMS-based Diffusion Tensor Imaging (DTI) tractography to visualize subcortical pathways and compared nTMS with DCS in 10 awake surgery patients.
Main Results:
- Postoperative evaluations showed significant preservation of VS function, with high recovery rates across various tests (e.g., 98.86% in the bell test).
- nTMS mapping guided surgical strategy, and tractography identified Superior Frontal Longitudinal Fasciculus II (SFLII) as a key subcortical bundle.
- Comparison with DCS yielded a specificity of 91.21% for nTMS, indicating high precision in identifying non-eloquent areas.
Conclusions:
- Preliminary findings suggest nTMS is a valuable tool for studying cognitive functions, particularly VS networks, in neurosurgical patients.
- nTMS aids in optimizing surgical planning, potentially reducing the risk of neurological impairment.
- Further research is warranted to validate these promising results and expand the clinical application of nTMS in neurosurgery.
