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Published on: August 12, 2019
Functional cortical mapping and structural subcortical anatomy predicts intra-operative speech arrest: a
Josephine Jung1, Kapil Rajwani2, Ana Mirallave-Pescador3
1Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK; Neurosciences Clinical Trials Unit, King's College Hospital NHS Foundation Trust, London, UK; Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, UK.
Combining navigated Transcranial Magnetic Stimulation (nTMS) with frontal aslant tract (FAT) and arcuate fasciculus (AF) tractography accurately predicts intraoperative speech arrest during awake brain surgery. This trilocation approach improves localization compared to individual methods.
Area of Science:
- Neurosurgery
- Neuroimaging
- Speech Mapping
Background:
- Navigated Transcranial Magnetic Stimulation (nTMS) is used for cortical speech mapping, but its positive predictive value (PPV) varies compared to direct electrical stimulation.
- Accurate pre-operative mapping is crucial for preserving speech function during brain surgery.
Purpose of the Study:
- To evaluate the accuracy of pre-operative nTMS combined with tractography of the frontal aslant tract (FAT) and arcuate fasciculus (AF) in predicting intraoperative speech arrest.
- To assess the utility of this combined approach (trilocation) compared to individual modalities.
Main Methods:
- A prospective, single-center study included patients undergoing awake surgery with pre-operative nTMS and FAT/AF tractography.
- Operative notes were reviewed for speech arrest, and data on demographics, histopathology, and pre-/post-operative language assessments were collected.
Main Results:
- Fifty-seven patients were included; 87.7% showed colocation of intraoperative speech arrest with nTMS and tractography.
- This trilocation significantly improved the accuracy of locating intraoperative speech arrest, especially for tumors involving the opercular Inferior Frontal Gyrus (opIFG), compared to nTMS or tractography alone (p < 0.01).
- The combined approach also demonstrated improved accuracy for IDH-wildtype tumors (p < 0.05).
Conclusions:
- Preoperative assessment of cortical-subcortical integration is essential for predicting intraoperative speech arrest.
- The combination of nTMS, FAT, and AF tractography (trilocation) is a valuable tool for predicting intraoperative speech arrest during awake brain surgery.
