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Effect of resting motor threshold availability on preoperative motor cortex localization using navigated-TMS in
Buntou Ro1, Manabu Tamura1, Atsushi Kuwano1
1Department of Neurosurgery, Tokyo Women's Medical University, Japan; Faculty of Advanced Techno-Surgery, Institute of Advanced Biomedical Engineering and Science, Graduate School of Medicine, Tokyo Women's Medical University, Japan.
Objective:
To assess the concordance between preoperative motor cortex mapping using navigated transcranial magnetic stimulation (nTMS) and intraoperative direct electrical stimulation (DES), and to determine whether the ability to obtain the resting motor threshold (RMT) affects mapping accuracy.
Methods:
Seventeen patients with motor or premotor cortical gliomas underwent preoperative nTMS and intraoperative DES. Motor mapping was performed using the RMT or, if unobtainable, the active motor threshold (AMT). Concordance between nTMS and DES was analyzed using Fisher's exact test.
Results:
Spatial concordance between nTMS and DES was observed in 9 of 12 patients (75 %) with measurable RMT. None of the five AMT-only cases demonstrated concordance. The difference in concordance rates between RMT and AMT-only cases was statistically significant (p = 0.026). Representative cases illustrate the relationship between RMT availability and mapping accuracy.
Conclusions:
Preoperative nTMS mapping showed high concordance with DES when the RMT was obtainable. The lack of an RMT may predict reduced intraoperative mapping reliability.
Significance:
RMT preoperative assessment can guide surgical planning, including the need for subcortical mapping or adjusted resection margins. These findings highlight the utility of nTMS for motor localization and emphasize the value of the RMT for predicting intraoperative mapping success.
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